Preliminary clinical outcomes of Latarjet-Patte coracoid transfer by arthroscopy vs. open surgery: Prospective multicentre study of 390 cases

Background: Calcar-guided short-stem Total Hip Arthroplasty (THA) is increasingly being used to preserve proximal femoral bone stock for potential later revision surgery. Objective: In this study, we aimed to expand the clinical evidence on calcar-guided short-stem THA used in daily clinical practice, focusing on clinical outcomes as well as radiographic signs of stress shielding and femoral bone loss. Methods: In a prospective multicentre study, we enrolled 213 patients with a total of 224 THAs for mainly degenerative indications. The patients were examined clinically and radiographically 6 to 12 weeks, 12 months, and 24 months postoperatively. Results: All clinical outcomes improved significantly over the first 6 to 12 weeks compared to preoperative values (P < 0.001). At 24 months, the mean Harris hip score was 95.3 ± 6.7, and the mean visual analogue scale for pain was 1.0 ± 1.7 under load and 0.5 ± 1.3 at rest. We observed early distal stem migration in six patients and late migration in one patient. Additionally, we found 16 cases of radiographic signs indicative of stress shielding. Four patients required stem revision surgery: two for stem migration, one for periprosthetic fracture, and one for deep infection. Conclusion: Overall, calcar-guided short-stem THA resulted in excellent clinical outcomes after two years of follow-up, and the radiographs revealed few signs of stress shielding. We, therefore, regard calcar-guided short-stem THA as a safe and effective treatment alternative in daily clinical practice.

Download Full-text

Post-therapeutic 6-week outcome of upper digestive bleeding (UDB9 in cirrhosis. Prospective multicentre study

Journal of Hepatology ◽

10.1016/s0168-8278(01)80200-2 ◽

2001 ◽

Vol 34 (0) ◽

pp. 59

Author(s):

G D'Amico

Keyword(s):

Multicentre Study ◽

Digestive Bleeding ◽

Prospective Multicentre Study

Download Full-text

Geriatric fracture centre vs usual care after proximal femur fracture in older patients: what are the benefits? Results of a large international prospective multicentre study

BMJ Open ◽

10.1136/bmjopen-2020-039960 ◽

2021 ◽

Vol 11 (5) ◽

pp. e039960

Author(s):

Michael Blauth ◽

Alexander Joeris ◽

Elke Rometsch ◽

Kathrin Espinoza-Rebmann ◽

Pannida Wattanapanom ◽

...

Keyword(s):

Adverse Events ◽

Multicentre Study ◽

Usual Care ◽

Proximal Femur ◽

Interdisciplinary Treatment ◽

Proximal Femur Fracture ◽

Geriatric Fracture ◽

Femur Fractures ◽

Prospective Multicentre Study ◽

Registration Number

ObjectiveThe aim of this study was to determine the effect of treatment in geriatric fracture centres (GFC) on the incidence of major adverse events (MAEs) in patients with hip fractures compared with usual care centres (UCC). Secondary objectives included hospital-workflow and mobility-related outcomes.DesignCohort study recruiting patients between June 2015 and January 2017. Follow-up was 1 year.SettingInternational (six countries, three continents) multicentre study.Participants281 patients aged ≥70 with operatively treated proximal femur fractures.InterventionsTreatment in UCCs (n=139) or GFCs (n=142), that is, interdisciplinary treatment including regular geriatric consultation and daily physiotherapy.Outcome measuresPrimary outcome was occurrence of prespecified MAEs, including delirium. Secondary outcomes included any other adverse events, time to surgery, time in acute ward, 1-year mortality, mobility, and quality of life.ResultsPatients treated in GFCs (n=142) had a mean age of 81.9 (SD, 6.6) years versus 83.9 (SD 6.9) years in patients (n=139) treated in UCCs (p=0.013) and a higher mean Charlson Comorbidity Index of 2.0 (SD, 2.1) versus 1.2 (SD, 1.5) in UCCs (p=0.001). More patients in GFCs (28.2%) experienced an MAE during the first year after surgery compared with UCCs (7.9%) with an OR of 4.56 (95% CI 2.23 to 9.34, p<0.001). Analysing individual MAEs, this was significant for pneumonia (GFC: 9.2%; UCC: 2.9%; OR, 3.40 (95% CI 1.08 to 10.70), p=0.027) and delirium (GFC: 11.3%; UCC: 2.2%, OR, 5.76 (95% CI 1.64 to 20.23), p=0.002).ConclusionsContrary to our study hypothesis, the rate of MAEs was higher in GFCs than in UCCs. Delirium was revealed as a main contributor. Most likely, this was based on improved detection rather than a truly elevated incidence, which we interpret as positive effect of geriatric comanagement.Trial registration numberClinicalTrials.gov: NCT02297581.

Download Full-text