Orthopaedic surgery

2021 ◽  
pp. 611-646
Author(s):  
Richard Griffiths ◽  
David Brooks

This chapter discusses the anaesthetic management of orthopaedic surgery. It begins with general principles of the anaesthetic management of orthopaedic surgical patients, including the management of fat embolism syndrome (FES), bone cement implantation syndrome (BCIS), and the use of tourniquets. Surgical procedures covered include total hip joint replacement (THJR) (including revision THJR); femoral neck fracture surgery; total knee joint replacement (TKJR); arthroscopy; cruciate ligament repair; ankle surgery; foot surgery; spinal surgery (including the cervical spine); shoulder surgery (including total shoulder joint replacement (TSJR)); elbow replacement surgery and hand surgery.

Author(s):  
Richard Griffiths ◽  
Ralph Leighton

This chapter discusses the anaesthetic management of orthopaedic surgery. It begins with general principles of the anaesthetic management of orthopaedic surgical patients, including the management of fat embolism syndrome, bone cement implantation syndrome, compartment syndrome, and the use of tourniquets. Surgical procedures covered include total hip joint replacement (including revision total hip joint replacement), femoral neck fracture surgery, total knee joint replacement, arthroscopy, cruciate ligament repair, ankle surgery, foot surgery, spinal surgery (including the cervical spine), shoulder surgery (including total shoulder joint replacement), elbow replacement surgery, hand surgery, and trauma, including fractures of limbs or spine.


Author(s):  
Richard Griffiths ◽  
Ralph Leighton

This chapter discusses the anaesthetic management of orthopaedic surgery. It begins with general principles of the anaesthetic management of orthopaedic surgical patients, including the management of fat embolism syndrome, bone cement implantation syndrome, compartment syndrome, and the use of tourniquets. Surgical procedures covered include total hip joint replacement (including revision total hip joint replacement), femoral neck fracture surgery, total knee joint replacement, arthroscopy, cruciate ligament repair, ankle surgery, foot surgery, spinal surgery (including the cervical spine), shoulder surgery (including total shoulder joint replacement), elbow replacement surgery, hand surgery, and trauma, including fractures of limbs or spine.


2017 ◽  
Vol 5 (1) ◽  
Author(s):  
Alberto Bazzocchi ◽  
Alessandra Bartoloni ◽  
Eugenio Rimondi ◽  
Ugo Albisinni ◽  
Giuseppe Guglielmi

2018 ◽  
Vol 33 (3) ◽  
pp. 925-930 ◽  
Author(s):  
Toru Nishiwaki ◽  
Ryosuke Hata ◽  
Akihito Oya ◽  
Masaya Nakamura ◽  
Morio Matsumoto ◽  
...  

2019 ◽  
Vol 6 (6) ◽  
Author(s):  
Meeri Honkanen ◽  
Esa Jämsen ◽  
Matti Karppelin ◽  
Reetta Huttunen ◽  
Antti Eskelinen ◽  
...  

Abstract Background The risk for developing a periprosthetic joint infection (PJI) during bacteremia is unclear, except for Staphylococcus aureus bacteremia. The aim of this study was to examine the risk for developing a PJI during bacteremia and to identify possible risk factors leading to it. Methods Patients with a primary knee or hip joint replacement performed in a tertiary care hospital between September 2002 and December 2013 were identified (n = 14 378) and followed up until December 2014. Positive blood culture results during the study period and PJIs were recorded. PJIs associated with an episode of bacteremia were identified and confirmed from patient records. Potential risk factors for PJI among those with bacteremia were examined using univariate logistic regression. Results A total of 542 (3.8%) patients had at least 1 episode of bacteremia. Seven percent (47/643) of the bacteremias resulted in a PJI. Development of a PJI was most common for Staphylococcus aureus (21% of bacteremias led to a PJI) and beta-hemolytic streptococci (21%), whereas it was rare for gram-negative bacteria (1.3%). Having ≥2 bacteremias during the study period increased the risk for developing a PJI (odds ratio, 2.29; 95% confidence interval, 1.17–4.50). The risk for developing a PJI was highest for bacteremias occurring within a year of previous surgery. Chronic comorbidities did not affect the risk for PJI during bacteremia. Conclusions The development of a PJI during bacteremia depends on the pathogen causing the bacteremia and the timing of bacteremia with respect to previous joint replacement surgery. However, significant patient-related risk factors for PJI during bacteremia could not be found.


2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
K Keller ◽  
L Hobohm ◽  
S Barco ◽  
I Schmidtmann ◽  
T Munzel ◽  
...  

Abstract Background Venous thromboembolism (VTE) is a frequent acute cardiovascular disease, leading to significant morbidity and mortality worldwide. Major trauma, surgery, immobilisation and joint replacements are major provoking factors for VTE. In particular, patients undergoing knee and hip joint replacement surgery are at high risk of developing VTE perioperatively, even in the era of established pharmacological thromboprophylaxis. Without thromboprophylaxis, as many as 20–60% of patients may develop perioperative VTE. Purpose As recent studies indicate an increasing number of total knee and hip replacement surgeries in European countries and the United States, aims of our study were to investigate a) total burden and temporal trends of VTE complications following knee (KJR) and hip joint replacement (HJR) in Germany 2005–2016 and to identify b) predictors of VTE during hospitalization. Methods In an analysis of the nationwide German inpatient sample, we included all hospitalized patients with elective primary KJR and HJR in Germany between 2005 and 2016 (source: Research Data Center (RDC) of the Federal Statistical Office and the Statistical Offices of the federal states, DRG Statistics 2005–2016, own calculations). We analyzed temporal trends of surgical procedure, mortality, and VTE, and identified predictors of VTE. Results A total of 1,804,496 hospitalized patients underwent KJR (65.1% women, 53.4% aged ≥70 years) and 1,885,839 received HJR (59.1% women, 51.4% ≥70 years). VTE was documented in 23,297 (1.3% of total) KJR patients and in 11,554 HJR patients (0.6%). The number of primary KJR (129,832 in 2005 to 167,881 in 2016 [β-(slope)-estimate 1978 per year; 95% CI 1951 to 2004, P<0.001]) and primary HJR (145,223 in 2005 to 171,421 in 2016 [β-estimate 1818 per year; 95% CI 1083 to 2553, P<0.001]) increased during this twelve-year period. In-hospital VTE decreased from 1.9% to 0.9% (β-estimate −0.77 [95% CI: −0.81 to −0.72], P<0.001) after KJR and from 0.9% to 0.5% (β-estimate −0.71 (95% CI: −0.77 to −0.65), P<0.001) after HJR. In parallel, in-hospital death rate dropped from 0.14% (184 deaths) to 0.09% (146 deaths) (β-estimate −0.44 [95% CI: −0.59 to −0.30], P<0.001) after KJR and from 0.33% to 0.29% (β-estimate −0.11 (95% CI: −0.20 to −0.02), P=0.018) after HJR. Infections during hospitalization were associated with a higher VTE risk. VTE events were associated with in-hospital death in KJR (OR 20.86 [95% CI: 18.78–23.15], P<0.001) and HJR (OR 15.19 [95% CI: 14.19–16.86], P<0.001) independently from age, sex and comorbidities. Conclusions While total numbers of KJR and HJR interventions increased in Germany between 2005 and 2016, the rate of VTE decreased substantially. VTE complications were associated with 15-to 21-fold increase of in-hospital case-fatality rate. Perioperative infections increased the risk for VTE substantially. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): This study was supported by the German Federal Ministry of Education and Research (BMBF 01EO1503), institutional grant for the Center for Thrombosis and Hemostasis. The authors are responsible for the contents of this publication.


Sign in / Sign up

Export Citation Format

Share Document