The Influence of Patellofemoral Degenerative Changes on the Outcome of the Unicompartmental Knee Replacement: A Prospective Study

2020 ◽  
Author(s):  
Ali Abdulkarim ◽  
Ayla C. Newton ◽  
Turlough O'Donnell ◽  
Michael J. Neil
Keyword(s):  
Perioperative Complications ◽  
Demographic Data ◽  
Length Of Hospital Stay ◽  
Medial Compartment ◽  
Unicompartmental Knee Replacement ◽  
Medial Compartment Osteoarthritis ◽  
Unicompartmental Knee ◽  
The Status ◽  
Group B ◽  
A Prospective Study

AbstractUnicompartmental knee arthroplasty (UKA) is a recognized procedure for treatment of medial compartment osteoarthritis. Patellofemoral (PF) joint degeneration is widely considered to be a contraindication to medial compartment UKA. We examined the validity of this preconception using information gathered prospectively on 147 consecutive patients who underwent the Repicci II UKA for medial compartment osteoarthritis between July 1999 and September 2000 by the same surgeon. The status of the PF joint was assessed intraoperatively in all patients, and accordingly patients were divided into two groups. Among them, 69 had associated PF osteoarthritis (group A), while 78 patients had a normal PF compartment (group B). Variables measured included the International Knee Society (IKS) score, limb alignment, and range of motion. Radiographs, demographic data, length of hospital stay, perioperative complications were also measured. All subsequent surgery and survivorship at 10 years were recorded. The mean follow-up was 9.4 years (range: 5–10.7 years) and results of the two groups were compared. We found no significant differences in terms of IKS scores, alignment, and flexion between the two groups. However, measured extension was significantly increased postoperatively in those patients with minimal or no PF joint degenerative disease (p < 0.05).

scholarly journals Outcome of intussusception among children in Kano

2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Lawal B. Abdullahi ◽  
Mohammad A. Mohammad ◽  
Lofty-John C. Anyanwu ◽  
Mohammad S. Aliyu ◽  
Bilya I. Liman
Keyword(s):  
Intestinal Obstruction ◽  
Demographic Data ◽  
Length Of Hospital Stay ◽  
Wound Dehiscence ◽  
Exploratory Laparotomy ◽  
Late Presentation ◽  
Adjacent Segment ◽  
Common Cause ◽  
A Prospective Study ◽  
Resection And Anastomosis

Intussusception is defined as the telescoping of a segment of the gastrointestinal tract within the lumen of the adjacent segment usually proximal to distal. It is a common cause of intestinal obstruction in children, rarely it can occur in adult. This condition is reported in both developed and developing countries, however there are few publications in Nigeria about the incidence, presentation and outcome of its management, most especially in children. This is a prospective study of pediatric patients managed in single center Kano over a period of 18months. The demographic data, clinical features, treatment and outcome of the management were evaluated and analyzed using SPSS version 23. Between June 2018 to December 2019, twenty-five children were managed with intussuception at Aminu Kano Teaching Hospital, there were 16 males and 9 females. The age of the patients ranges between 5 months to 6 years with most of patients in the ager range between 6 and 12 months. All of the 25 patients had exploratory laparotomy with manual reduction in 12 patients, while 13 patients had resection and anastomosis. Non-operative reduction using normal saline under ultrasound guidance was attempted for 2 patients, which was not successful. The length of hospital stay ranged between 4 days and 22 days. Few complications were observed which includes surgical site infection, wound dehiscence, postoperative ileus. One patient was re-operated for recurrent intussuception. Two patients died post operatively, while 23 patients were discharged home alive. Intussuception is still a common cause of intestinal obstruction in children in Kano. Late presentation was found to be associated with higher morbidity (complications).

scholarly journals Robotic-assisted unicompartmental knee arthroplasty has a greater early functional outcome when compared to manual total knee arthroplasty for isolated medial compartment arthritis

2020 ◽  
Vol 9 (1) ◽  
pp. 15-22 ◽  
Author(s):  
Nicholas D. Clement ◽  
Allison Bell ◽  
Philip Simpson ◽  
Gavin Macpherson ◽  
James T. Patton ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Hospital Stay ◽  
Functional Outcome ◽  
Knee Arthroplasty ◽  
Unicompartmental Knee Arthroplasty ◽  
Length Of Hospital Stay ◽  
Medial Compartment ◽  
Health Improvement ◽  
Unicompartmental Knee ◽  
Total Knee

Aims The primary aim of the study was to compare the knee-specific functional outcome of robotic unicompartmental knee arthroplasty (rUKA) with manual total knee arthroplasty (mTKA) for the management of isolated medial compartment osteoarthritis. Secondary aims were to compare length of hospital stay, general health improvement, and satisfaction between rUKA and mTKA. Methods A powered (1:3 ratio) cohort study was performed. A total of 30 patients undergoing rUKA were propensity score matched to 90 patients undergoing mTKA for isolated medial compartment arthritis. Patients were matched for age, sex, body mass index (BMI), and preoperative function. The Oxford Knee Score (OKS) and EuroQol five-dimension questionnaire (EQ-5D) were collected preoperatively and six months postoperatively. The Forgotten Joint Score (FJS) and patient satisfaction were collected six months postoperatively. Length of hospital stay was also recorded. Results There were no significant differences in the preoperative demographics (p ⩾ 0.150) or function (p ⩾ 0.230) between the groups. The six-month OKS was significantly greater in the rUKA group when compared with the mTKA group (difference 7.7, p < 0.001). There was also a greater six-month postoperative EQ-5D (difference 0.148, p = 0.002) and FJS (difference 24.2, p < 0.001) for the rUKA when compared to the mTKA. No patient was dissatisfied in the rUKA group and five (6%) were dissatisfied in the mTKA, but this was not significant (p = 0.210). Length of stay was significantly (p < 0.001) shorter in the rUKA group (median two days, interquartile range (IQR) 1 to 3) compared to the mTKA (median four days, IQR 3 to 5). Conclusion Patients with isolated medial compartment arthritis had a greater knee-specific functional outcome and generic health with a shorter length of hospital stay after rUKA when compared to mTKA. Cite this article: Bone Joint Res 2019;9(1):15–22.

scholarly journals Anesthesia for Awake Craniotomy in Patients with Metastatic Brain Tumor in Ibadan, Nigeria

2020 ◽  
Vol 5 (2) ◽  
Keyword(s):  
Brain Tumor ◽  
Conscious Sedation ◽  
Parietal Lobe ◽  
Perioperative Complications ◽  
Demographic Data ◽  
Length Of Hospital Stay ◽  
Metastatic Brain Tumor ◽  
Awake Craniotomy ◽  
Anaesthetic Technique ◽  
Scalp Block

Introduction: Craniotomies can be performed under general anaesthesia or with the patients awake known as awake craniotomy. Awake craniotomy requires that the patients be conscious and cooperative during intraoperative neurological testing. Methods: This was a retrospective study of the anaesthetic protocol and the complications encountered during the perioperative management of patients who had awake craniotomy for metastatic brain resection in a developing country over a 3- year period. The information retrieved were demographic data, tumor location, anaesthetic technique and perioperative complications. Results: There were ten patients comprising of 9 (90%) females and 1 (10%) male. The age ranged from 33 to 66 years with a mean age of 44.00 ± 12.02 years. Eight patients had metastatic brain tumor from the breast carcinoma, one from the lung and the last patient had metastasis from the colon. Four patients had tumor excision from the frontal lobe while 6 patients had excision from the parietal lobe. They all had solitary brain tumor. The anaesthetic technique used was conscious sedation and scalp block. Propofol and fentanyl were used for the conscious sedation while 0.25% Plain Bupivacaine and 1% Lidocaine with adrenaline (1: 200,00) were used for the scalp block. Patients were allowed to breathe spontaneously 100% oxygen. Two patients had respiratory depression with oxygen saturation less than 95% and laryngeal mask airway was inserted. Hypertension and tachycardia were seen in 4 patients, focal seizure in 2 patients and aphasia in 1 patient. Intensive care unit admission was for 24 hours and the today length of hospital stay was 2-7 days. No mortality in this series. Conclusion: Conscious sedation with scalp block is a safe and a tolerable technique for awake craniotomy. The complications observed were minimal and can be treated to obtain a good outcome.

scholarly journals Predictors of long length of hospital stay among elders admitted with seizures in a tertiary centre: a prospective study

2020 ◽  
Vol 78 (11) ◽  
pp. 687-694 ◽  
Author(s):  
Aroldo BACELLAR ◽  
Telma Rocha de ASSIS ◽  
Bruno Bacellar PEDREIRA ◽  
Luan CÔRTES ◽  
Silas SANTANA ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Hospital Stay ◽  
Neurological Disorders ◽  
Demographic Data ◽  
Length Of Hospital Stay ◽  
Epileptic Seizures ◽  
Tertiary Centre ◽  
Elderly Inpatients ◽  
A Prospective Study ◽  
Early Seizure

ABSTRACT Population ageing is a global phenomenon, and life expectancy in Brazil is growing fast. Epilepsy is the third most important chronic neurological disorder, and its incidence is higher among elderly patients than in any other segment of the population. The prevalence of epilepsy is greater among inpatients than in the general population and it is related to long length of hospital stay (LOS), which is associated with hospital mortality and higher healthcare costs. Despite these facts, reports of elderly inpatients admitted with seizures and associated outcomes are scarce. Objective: To identify predictors of long LOS among elderly inpatients admitted with seizures. Methods: We prospectively enrolled elders admitted with epileptic seizures or who experienced seizures throughout hospitalization between November 2015 and August 2019. We analysed demographic data, neurological disorders, clinical comorbidities, and seizure features to identify risk factors. Results: The median LOS was 11 days, with an interquartile range (IQR) of 5-21 days. The frequency of long LOS (defined as a period of hospitalization ≥12 days) was 47%. Multivariate analysis showed there was an exponential increase in long LOS if a patient showed any of the following conditions: intensive care unit (ICU) admission (OR=4.562), urinary tract infection (OR=3.402), movement disorder (OR=5.656), early seizure recurrence (OR=2.090), and sepsis (OR=4.014). Conclusion: Long LOS was common among elderly patients admitted with seizures, and most predictors of long LOS found in this cohort might be avoidable; these findings should be confirmed with further research.

Robot-assisted unicompartmental knee arthroplasty for patients with isolated medial compartment osteoarthritis is cost-effective

2019 ◽  
Vol 101-B (9) ◽  
pp. 1063-1070 ◽  
Author(s):  
Nick D. Clement ◽  
David J. Deehan ◽  
James T. Patton
Keyword(s):  
Hospital Stay ◽  
Knee Arthroplasty ◽  
Unicompartmental Knee Arthroplasty ◽  
Length Of Hospital Stay ◽  
Cost Effective ◽  
High Volume ◽  
Medial Compartment ◽  
Case Volume ◽  
Unicompartmental Knee ◽  
The Cost

Aims The primary aim of the study was to perform an analysis to identify the cost per quality-adjusted life-year (QALY) of robot-assisted unicompartmental knee arthroplasty (rUKA) relative to manual total knee arthroplasty (TKA) and unicompartmental knee arthroplasty (UKA) for patients with isolated medial compartment osteoarthritis (OA) of the knee. Secondary aims were to assess how case volume and length of hospital stay influenced the relative cost per QALY. Patients and Methods A Markov decision analysis was performed, using known parameters for costs, outcomes, implant survival, and mortality, to assess the cost-effectiveness of rUKA relative to manual TKA and UKA for patients with isolated medial compartment OA of the knee with a mean age of 65 years. The influence of case volume and shorter hospital stay were assessed. Results Using a model with an annual case volume of 100 patients, the cost per QALY of rUKA was £1395 and £1170 relative to TKA and UKA, respectively. The cost per QALY was influenced by case volume: a low-volume centre performing ten cases per year would achieve a cost per QALY of £7170 and £8604 relative to TKA and UKA. For a high-volume centre performing 200 rUKAs per year with a mean two-day length of stay, the cost per QALY would be £648; if performed as day-cases, the cost would be reduced to £364 relative to TKA. For a high-volume centre performing 200 rUKAs per year with a shorter length of stay of one day relative to manual UKA, the cost per QALY would be £574. Conclusion rUKA is a cost-effective alternative to manual TKA and UKA for patients with isolated medial compartment OA of the knee. The cost per QALY of rUKA decreased with reducing length of hospital stay and with increasing case volume, compared with TKA and UKA. Cite this article: Bone Joint J 2019;101-B:1063–1070.

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