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J.b. Murray - One of the best experts on this subject based on the ideXlab platform.
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OUTCOMES IN 807 THOMPSON Hip Hemiarthroplasty PROCEDURES PERFORMED VIA EITHER AN ANTEROLATERAL APPROACH OR A POSTERIOR APPROACH WITH ENHANCED SOFT-TISSUE REPAIR
2018Co-Authors: Abram S.g.f., J.b. MurrayAbstract:Recent National Institute for Health and Care Excellence (NICE) guidance has advised against the continued use of the Thompson implant when performing Hip Hemiarthroplasty and recommended surgeons consider using the anterolateral surgical approach over a posterior approach.Our objective was to review outcomes from a consecutive series of Thompson Hip Hemiarthroplasty procedures performed in our unit and to identify any factors predicting the risk of complications.807 Thompson Hip Hemiarthroplasty cases performed between April 2008 and November 2013 were reviewed. 721 (89.3%) were cemented and 86 (10.7%) uncemented. 575 (71.3%) were performed in female patients. The anterolateral approach was performed in 753 (93.3%) and the posterior approach with enhanced soft tissue repair in 54 (6.7%).Overall, there were 23 dislocations (2.9%). Dislocation following the posterior approach occurred in 13.0% (7 of 54) in comparison to 2.1% (16 of 753) with the anterolateral approach (odds ratio (OR) 8.5 (95% CI 2.8 to 26...
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OUTCOMES IN 807 THOMPSON Hip Hemiarthroplasty PROCEDURES PERFORMED VIA EITHER AN ANTEROLATERAL APPROACH OR A POSTERIOR APPROACH WITH ENHANCED SOFT-TISSUE REPAIR
Journal of Bone and Joint Surgery-british Volume, 2015Co-Authors: Simon G F Abram, J.b. MurrayAbstract:Recent National Institute for Health and Care Excellence (NICE) guidance has advised against the continued use of the Thompson implant when performing Hip Hemiarthroplasty and recommended surgeons consider using the anterolateral surgical approach over a posterior approach. Our objective was to review outcomes from a consecutive series of Thompson Hip Hemiarthroplasty procedures performed in our unit and to identify any factors predicting the risk of complications. 807 Thompson Hip Hemiarthroplasty cases performed between April 2008 and November 2013 were reviewed. 721 (89.3%) were cemented and 86 (10.7%) uncemented. 575 (71.3%) were performed in female patients. The anterolateral approach was performed in 753 (93.3%) and the posterior approach with enhanced soft tissue repair in 54 (6.7%). Overall, there were 23 dislocations (2.9%). Dislocation following the posterior approach occurred in 13.0% (7 of 54) in comparison to 2.1% (16 of 753) with the anterolateral approach (odds ratio (OR) 8.5 (95% CI 2.8 to 26.3) p Patients were discharged home in 459 cases (56.9%), to a care home or other hospital in 273 cases (33.8%). 51.8% (338 of 653) returned home within 30 days. 75 died during their admission (9.3%). 30-day mortality was 7.1% and 1-year mortality was 16.6%. Intraoperative fracture occurred in 15 cases (1.9%) of which 14 were cemented. Superficial or deep infection occurred in 33 cases (4.1%). We recommend against the continued use of the posterior approach in Hip Hemiarthroplasty, as enhanced soft tissue repair did not reduce dislocation rates to an acceptable level. Our findings, however, demonstrate satisfactory results for patients treated with the Thompson Hip Hemiarthroplasty performed through an anterolateral approach. We suggest that the continued use of the Thompson implant in a carefully selected patient cohort is justifiable.
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Outcomes of 807 Thompson Hip Hemiarthroplasty procedures and the effect of surgical approach on dislocation rates.
Injury, 2015Co-Authors: Simon G F Abram, J.b. MurrayAbstract:Abstract The majority of displaced intracapsular fractures in our unit are managed with a Thompson Hip Hemiarthroplasty. Recent UK guidance from the National Institute for Health and Care Excellence has, however, advised against the continued used of the Thompson implant in patients with Hip fracture. The aim of this study was to review the outcomes and complications after Thompson Hip Hemiarthroplasty, including the impact of modern surgical approaches and cementing, whilst controlling for confounding factors. We reviewed the outcomes following Thompson Hip Hemiarthroplasty from a series of 807 cases performed between April 2008 and November 2013. Of these, 721 (89.3%) were cemented and 86 (10.7%) uncemented. A total of 575 (71.3%) procedures were performed in female patients. The anterolateral approach was performed in 753 (93.3%) and the posterior approach with enhanced soft tissue repair in 54 (6.7%). Overall, there were 23 dislocations (2.9%). Dislocation following the posterior approach occurred in 13.0% (seven of 54) in comparison to 2.1% (16 of 753) with the anterolateral approach (odds ratio (OR) 8.5 (95% confidence interval (CI) 2.8–26.3), p We recommend against the continued use of the posterior approach in Hip Hemiarthroplasty, as enhanced soft tissue repair did not reduce the dislocation rates to an acceptable level in this series utilising the Thompson implant. Our findings, however, demonstrate satisfactory results for patients treated with the Thompson Hip Hemiarthroplasty performed through an anterolateral approach. We suggest that the continued use of this implant in a carefully selected patient cohort is justifiable.
Mike R. Reed - One of the best experts on this subject based on the ideXlab platform.
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ANTIBIOTIC RESISTANCE PROFILES OF SURGICAL SITE INFECTIONS IN Hip Hemiarthroplasty: COMPARING LOW-DOSE SINGLE ANTIBIOTIC VERSUS HIGH-DOSE DUAL ANTIBIOTIC IMPREGNATED CEMENT
2018Co-Authors: Ben Tyas, Martin Marsh, T. Oswald, Ramsay Refaie, Catherine Molyneux, Mike R. ReedAbstract:AimThe incidence of fractured neck of femur (FNOF) is increasing yearly. Many of these patients undergo Hip Hemiarthroplasty. High dose dual-antibiotic cement (HDDAC) has been shown to reduce rates of deep surgical site infection (SSI) when compared to the current standard low dose single-antibiotic cement (LDSAC) in a quasi-randomised controlled trial. Some concerns exist regarding the use of HDDAC and the development of resistance. We reviewed cases of infection in LDSAC and HDDAC bone cement with regard to causative organism and resistance profile.MethodA retrospective analysis was undertaken of all hemiarthroplasties within our trust from April 2008 to December 2014. We identified all patients in this time period who acquired a deep SSI from the trust SSI surveillance database. The infecting organisms and susceptibility patterns were collated for each cement.ResultsWe identified 1941 hemiarthroplasties. There were 36 deep surgical site infections representing an infection rate of 3.1% in LDSAC patient...
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HIGH DOSE, DOUBLE ANTIBIOTIC-IMPREGNATED CEMENT REDUCES SURGICAL SITE INFECTION (SSI) IN Hip Hemiarthroplasty: A RANDOMISED CONTROLLED TRIAL OF 848 PATIENTS WITH INTRACAPSULAR NECK OF FEMUR FRACTURES
Journal of Bone and Joint Surgery-british Volume, 2013Co-Authors: C. Jensen, S. Gupta, Andrew P. Sprowson, S. Chambers, D. Inman, S. Jones, N. M. Aradhyula, Mike R. ReedAbstract:Currently, the cement being used for hemiarthroplasties and total Hip replacements by the authors and many other surgeons in the UK is Palacos® (containing 0.5g Gentamicin). Similar cement, Copal® (containing 1g Gentamicin and 1g Clindamycin) has been used in revision arthroplasties, and has shown to be better at inhibiting bacterial growth and biofilm formation. We aim to investigate the effect on SSI rates of doubling the gentamicin dose and adding a second antibiotic (clindamycin) to the bone cement in Hip Hemiarthroplasty. We randomised 848 consecutive patients undergoing cemented Hip Hemiarthroplasty for fractured NOF at one NHS trust (two sites) into two groups: Group I, 464 patients, received standard cement (Palacos®) and Group II, 384 patients, received high dose, double antibiotic-impregnated cement (Copal®). We calculated the SSI rate for each group at 30 days post-surgery. The patients, reviewers and statistician were blinded as to treatment group. The demographics and co-morbid conditions (known to increase risk of infection) were statistically similar between the groups. The combined superficial and deep SSI rates were 5 % (20/394) and 1.7% (6/344) for groups I and II respectively (p=0.01). Group I had a deep infection rate 3.3 %(13/394) compared to 1.16% (4/344) in group II (p=0.082). Group I had a superficial infection rate 1.7 % (7/394) compared to 0.58% (2/344) in group II (p=0.1861). 33(4%) patients were lost to follow up, and 77 (9%) patients were deceased at the 30 day end point. There was no statistical difference in the 30 day mortality, C. difficile infection, or the renal failure rates between the two groups. Using high dose double antibiotic-impregnated cement rather than standard low dose antibiotic-impregnated cement significantly reduced the SSI rate (1.7% vs 5%; p=0.01) after Hip Hemiarthroplasty for fractured neck of femur in this prospective randomised controlled trial.
Tatu J. Mäkinen - One of the best experts on this subject based on the ideXlab platform.
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Complications following conversion of a Hip Hemiarthroplasty to a total Hip arthroplasty
International Orthopaedics, 2015Co-Authors: Simcha G. Fichman, Tatu J. Mäkinen, Alex Vincent, Benjamin Lozano, Oleg Safir, Paul R.t. KuzykAbstract:Purpose Conversion of Hip Hemiarthroplasty to total Hip arthroplasty (CTHA) is a complication-prone procedure with high dislocation rates and early component loosening. The purpose of this study was to evaluate the complications of CTHA performed using contemporary implants. Methods Forty-six patients who had CTHA were retrospectively matched to a control group of 46 patients who had a first-time THA revision. The mean follow-up was 47 (range 6–149) and 23 (range 6–139) months for CTHA and control groups, respectively. Radiographs taken at the last follow-up visit were evaluated for signs of loosening or other modes of failure. Clinical outcome was evaluated with the Harris Hip Score (HHS). Results Complications occurred in five patients (10.9 %) in the CTHA group, and all required repeat revision. Two patients (4.3 %) were revised due to recurrent dislocation. The other re-revisions were done for acetabular or femoral component loosening and deep infection. In the control group, complications occurred in six patients (13.0 %), and three (6.5 %) were revised with a constrained liner due to recurrent dislocations. Conclusions Dislocation rates and re-revision for CTHA were not significantly different than those of first-time THA revision when using contemporary revision implants.
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Complications following conversion of a Hip Hemiarthroplasty to a total Hip arthroplasty
International orthopaedics, 2015Co-Authors: Simcha G. Fichman, Tatu J. Mäkinen, Alex Vincent, Benjamin Lozano, Oleg Safir, Paul R.t. KuzykAbstract:Purpose Conversion of Hip Hemiarthroplasty to total Hip arthroplasty (CTHA) is a complication-prone procedure with high dislocation rates and early component loosening. The purpose of this study was to evaluate the complications of CTHA performed using contemporary implants.
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Dislocation of Hip Hemiarthroplasty following posterolateral surgical approach: a nested case–control study
International Orthopaedics, 2012Co-Authors: Rami Madanat, Tatu J. Mäkinen, Mikko T. Ovaska, Martti Soiva, Tero Vahlberg, Jussi HaapalaAbstract:Purpose Hip Hemiarthroplasty dislocation is a serious complication in treatment of displaced intracapsular Hip fractures. We investigated factors associated with an increased risk of dislocation after cemented Hip Hemiarthroplasty following the posterolateral approach. Methods Between January 2002 and December 2008, 602 Hip fractures were treated with cemented unipolar Hip Hemiarthroplasty. A registry-based analysis was carried out to determine the total number of Hemiarthroplasty dislocations in these patients. A control group of 96 patients without dislocation was randomly selected. Logistic regression analysis was performed to evaluate clinical and operative factors associated with dislocation. Results Thirty-four patients (5.6%) experienced at least one dislocation. Most were the result of a fall and occurred within two months after surgery. There was a trend for increased dislocation in patients who had been operated on more than 48 hours after admission and in patients who had a longer operative time. Smaller centre-edge angle and Hip offset were observed in patients with dislocation. Recurrent dislocation was a significant problem, as 18 patients (62%) experienced multiple dislocations. Conclusions The risk of Hemiarthroplasty dislocation following the posterolateral surgical approach may be reduced by prompt surgical treatment and fall prevention in the early postoperative period. Patients with smaller acetabular coverage seem more predisposed to dislocation after the posterolateral approach and may be more suitable for other surgical approaches.
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dislocation of Hip Hemiarthroplasty following posterolateral surgical approach a nested case control study
International Orthopaedics, 2012Co-Authors: Rami Madanat, Tatu J. Mäkinen, Mikko T. Ovaska, Martti Soiva, Tero Vahlberg, Jussi HaapalaAbstract:Purpose Hip Hemiarthroplasty dislocation is a serious complication in treatment of displaced intracapsular Hip fractures. We investigated factors associated with an increased risk of dislocation after cemented Hip Hemiarthroplasty following the posterolateral approach.
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Dislocation of Hip Hemiarthroplasty following posterolateral surgical approach: a nested case–control study
International orthopaedics, 2011Co-Authors: Rami Madanat, Tatu J. Mäkinen, Mikko T. Ovaska, Martti Soiva, Tero Vahlberg, Jussi HaapalaAbstract:Purpose Hip Hemiarthroplasty dislocation is a serious complication in treatment of displaced intracapsular Hip fractures. We investigated factors associated with an increased risk of dislocation after cemented Hip Hemiarthroplasty following the posterolateral approach.
Paul R.t. Kuzyk - One of the best experts on this subject based on the ideXlab platform.
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Complications following conversion of a Hip Hemiarthroplasty to a total Hip arthroplasty
International Orthopaedics, 2015Co-Authors: Simcha G. Fichman, Tatu J. Mäkinen, Alex Vincent, Benjamin Lozano, Oleg Safir, Paul R.t. KuzykAbstract:Purpose Conversion of Hip Hemiarthroplasty to total Hip arthroplasty (CTHA) is a complication-prone procedure with high dislocation rates and early component loosening. The purpose of this study was to evaluate the complications of CTHA performed using contemporary implants. Methods Forty-six patients who had CTHA were retrospectively matched to a control group of 46 patients who had a first-time THA revision. The mean follow-up was 47 (range 6–149) and 23 (range 6–139) months for CTHA and control groups, respectively. Radiographs taken at the last follow-up visit were evaluated for signs of loosening or other modes of failure. Clinical outcome was evaluated with the Harris Hip Score (HHS). Results Complications occurred in five patients (10.9 %) in the CTHA group, and all required repeat revision. Two patients (4.3 %) were revised due to recurrent dislocation. The other re-revisions were done for acetabular or femoral component loosening and deep infection. In the control group, complications occurred in six patients (13.0 %), and three (6.5 %) were revised with a constrained liner due to recurrent dislocations. Conclusions Dislocation rates and re-revision for CTHA were not significantly different than those of first-time THA revision when using contemporary revision implants.
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Complications following conversion of a Hip Hemiarthroplasty to a total Hip arthroplasty
International orthopaedics, 2015Co-Authors: Simcha G. Fichman, Tatu J. Mäkinen, Alex Vincent, Benjamin Lozano, Oleg Safir, Paul R.t. KuzykAbstract:Purpose Conversion of Hip Hemiarthroplasty to total Hip arthroplasty (CTHA) is a complication-prone procedure with high dislocation rates and early component loosening. The purpose of this study was to evaluate the complications of CTHA performed using contemporary implants.
Simon G F Abram - One of the best experts on this subject based on the ideXlab platform.
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OUTCOMES IN 807 THOMPSON Hip Hemiarthroplasty PROCEDURES PERFORMED VIA EITHER AN ANTEROLATERAL APPROACH OR A POSTERIOR APPROACH WITH ENHANCED SOFT-TISSUE REPAIR
Journal of Bone and Joint Surgery-british Volume, 2015Co-Authors: Simon G F Abram, J.b. MurrayAbstract:Recent National Institute for Health and Care Excellence (NICE) guidance has advised against the continued use of the Thompson implant when performing Hip Hemiarthroplasty and recommended surgeons consider using the anterolateral surgical approach over a posterior approach. Our objective was to review outcomes from a consecutive series of Thompson Hip Hemiarthroplasty procedures performed in our unit and to identify any factors predicting the risk of complications. 807 Thompson Hip Hemiarthroplasty cases performed between April 2008 and November 2013 were reviewed. 721 (89.3%) were cemented and 86 (10.7%) uncemented. 575 (71.3%) were performed in female patients. The anterolateral approach was performed in 753 (93.3%) and the posterior approach with enhanced soft tissue repair in 54 (6.7%). Overall, there were 23 dislocations (2.9%). Dislocation following the posterior approach occurred in 13.0% (7 of 54) in comparison to 2.1% (16 of 753) with the anterolateral approach (odds ratio (OR) 8.5 (95% CI 2.8 to 26.3) p Patients were discharged home in 459 cases (56.9%), to a care home or other hospital in 273 cases (33.8%). 51.8% (338 of 653) returned home within 30 days. 75 died during their admission (9.3%). 30-day mortality was 7.1% and 1-year mortality was 16.6%. Intraoperative fracture occurred in 15 cases (1.9%) of which 14 were cemented. Superficial or deep infection occurred in 33 cases (4.1%). We recommend against the continued use of the posterior approach in Hip Hemiarthroplasty, as enhanced soft tissue repair did not reduce dislocation rates to an acceptable level. Our findings, however, demonstrate satisfactory results for patients treated with the Thompson Hip Hemiarthroplasty performed through an anterolateral approach. We suggest that the continued use of the Thompson implant in a carefully selected patient cohort is justifiable.
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Outcomes of 807 Thompson Hip Hemiarthroplasty procedures and the effect of surgical approach on dislocation rates.
Injury, 2015Co-Authors: Simon G F Abram, J.b. MurrayAbstract:Abstract The majority of displaced intracapsular fractures in our unit are managed with a Thompson Hip Hemiarthroplasty. Recent UK guidance from the National Institute for Health and Care Excellence has, however, advised against the continued used of the Thompson implant in patients with Hip fracture. The aim of this study was to review the outcomes and complications after Thompson Hip Hemiarthroplasty, including the impact of modern surgical approaches and cementing, whilst controlling for confounding factors. We reviewed the outcomes following Thompson Hip Hemiarthroplasty from a series of 807 cases performed between April 2008 and November 2013. Of these, 721 (89.3%) were cemented and 86 (10.7%) uncemented. A total of 575 (71.3%) procedures were performed in female patients. The anterolateral approach was performed in 753 (93.3%) and the posterior approach with enhanced soft tissue repair in 54 (6.7%). Overall, there were 23 dislocations (2.9%). Dislocation following the posterior approach occurred in 13.0% (seven of 54) in comparison to 2.1% (16 of 753) with the anterolateral approach (odds ratio (OR) 8.5 (95% confidence interval (CI) 2.8–26.3), p We recommend against the continued use of the posterior approach in Hip Hemiarthroplasty, as enhanced soft tissue repair did not reduce the dislocation rates to an acceptable level in this series utilising the Thompson implant. Our findings, however, demonstrate satisfactory results for patients treated with the Thompson Hip Hemiarthroplasty performed through an anterolateral approach. We suggest that the continued use of this implant in a carefully selected patient cohort is justifiable.