scholarly journals Risk factors for intra-operative and post-operative fractures associated with primary total ankle replacement surgery - a data linkage study from the UK National Joint Registry

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0053
Author(s):  
Razi Zaidi ◽  
Andrew Goldberg
Keyword(s):  
Logistic Regression ◽  
Data Linkage ◽  
Patient Characteristics ◽  
Linkage Study ◽  
Total Ankle Replacement ◽  
National Joint Registry ◽  
Joint Registry ◽  
Replacement Surgery ◽  
Ankle Replacement ◽  
The Uk

Category: Ankle Introduction/Purpose: Intra and post-operative fractures are recognised complications of total ankle replacement (TAR) surgery. Intra-operative fractures are captured on the National Joint Registry (NJR) in the UK. The NJR has been capturing data on ankle replacement surgery since April 2010 and the number of TARs on the register is approaching 4000. Post-operative fractures are captured in the Hospital Episodes Statistics (HES) database. HES stores all patients admitted to NHS hospitals in England and captures 125 million records each year. Diagnostic information is stored using the International Classification of Diseases (ICD) and operative details using the Office of Population, Censuses and Surveys Classification (OPCS) codes. The purpose of this work was to determine the rate of intra and post-operative fracture with primary TAR and determine risk factors. Methods: A data-linkage study of the UK National Joint Registry (NJR) data and Hospital Episodes Statistics (HES) database was peformed using the first 3 years of NJR data. These two databases were linked in a deterministic fashion. 1522 NJR records were linked with the HES data set of over 90 million records. 1110 records were able to linked and available for analysis. Unlinked NJR data was analysed to identify intra-operative fractures. Linked data was analysed to identify post-operative fractures using ICD codes. Logistic regression was used to model predictors of intra and post-operative fractures. Every model was adjusted for patient characteristics including age, BMI, comorbidity and ASA grade. Results: The rate of intra-operative fracture was 2.69% (95% CI 2.67% to 2.74%). When looking at patient characteristics no significant predictors emerged. Logistic regression adjusted for patient characteristics showed that patients with rheumatoid arthritis were twice as likely to have a intra-operative fractures. The rate of post-operative fracture in the 12 months following primary TAR was 1.08% (95% CI 1.05% to 1.14%). Age emerged as a risk factor with a 5 five fold increase in risk of post-operative fracture with age 65-74 compared with those below 65. Adjusted logistic regression showed an increase risk of post-operative fracture in rheumatoid patients, hybrid operations and with those with multiple concurrent procedures. The risk of fracture was doubled with one associated procedure and tripled with two procedures. Conclusion: The rate of intra and post-operative fracture associated with primary total ankle replacement is low. However care should be taken with patients over 65 as they are at greater risk of intra operative fractures. Patients with rheumatoid arthritis are at greater risk of both, likely due to the effect of drug treatment. All efforts should be made to review medications and bone protective medication prescribed for these patents when undergoing TAR.

scholarly journals Pulmonary embolism and mortality following total ankle replacement: a data linkage study using the NJR data set

BMJ Open ◽  
2016 ◽  
Vol 6 (6) ◽  
pp. e011947 ◽  
Author(s):  
Razi Zaidi ◽  
Alexander MacGregor ◽  
Suzie Cro ◽  
Andy Goldberg
Keyword(s):  
Pulmonary Embolism ◽  
Data Linkage ◽  
Linkage Study ◽  
Total Ankle Replacement ◽  
Data Set ◽  
Ankle Replacement

Primary total ankle replacement surgery is a cost-effective intervention

The Foot ◽  
2021 ◽  
Vol 49 ◽  
pp. 101830
Author(s):  
Zach J. Place ◽  
Deborah J. Macdonald ◽  
Nicholas D. Clement ◽  
Hisham Shalaby ◽  
John C. McKinley
Keyword(s):  
Cost Effective ◽  
Total Ankle Replacement ◽  
Effective Intervention ◽  
Replacement Surgery ◽  
Ankle Replacement

scholarly journals PCN226 LUNG CANCER PATIENT CHARACTERISTICS FROM A DATA LINKAGE STUDY

2020 ◽  
Vol 23 ◽  
pp. S62
Author(s):  
Y. Zhang ◽  
M. Simoff ◽  
D. Ost ◽  
O. Wagner ◽  
J. Lavin ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Cancer Patient ◽  
Lung Cancer Patient ◽  
Data Linkage ◽  
Patient Characteristics ◽  
Linkage Study

scholarly journals Total Ankle Replacement Requiring Distal Tibiofibular Arthrodesis in a Dog

VCOT Open ◽  
2021 ◽  
Vol 04 (01) ◽  
pp. e12-e19
Author(s):  
Neil J. Burton ◽  
Maciej Krukowski
Keyword(s):  
Computed Tomography ◽  
Case Report ◽  
Surgical Technique ◽  
Tibial Component ◽  
Subjective Assessment ◽  
Total Ankle Replacement ◽  
Labrador Retriever ◽  
Radiological Assessment ◽  
Replacement Surgery ◽  
Ankle Replacement

AbstractThis case report describes distal tibiofibular arthrodesis as a technique for achieving increased confluent bone support for the placement of oversized arthroplasty components for talocrural arthroplasty in an 18-month-old Labrador Retriever with talocrural osteoarthritis secondary to talar osteochondrosis. Computed tomography assessment for suitability for BioMedtrix canine ankle replacement surgery revealed the tibia to be undersized relative to the tibial component. Distal tibiofibular arthrodesis was performed to increase lateral bone support to permit placement of an otherwise oversized prosthesis. Subjective assessment of outcome with owner Liverpool Osteoarthritis in Dogs questionnaire to 6 months postoperatively as well as radiological assessment to 4 months postoperatively documented significant improvement in lameness in the operated limb with no complications. Distal tibiofibular arthrodesis is a means by which to achieve increased bone support prior to BioMedtrix canine total ankle replacement surgery. The surgical technique described herein permitted placement of an oversized talocrural prosthesis in this patient with good clinical function. This technique may permit use of this arthroplasty system in otherwise undersized patients until such a time that smaller implants are available from the manufacturer.

scholarly journals Risk Factors for Periprosthetic Joint Infection Following Total Ankle Replacement

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0040
Author(s):  
Niall A. Smyth ◽  
John G. Kennedy ◽  
Lew C. Schon ◽  
Javad Parvizi ◽  
Amiethab A. Aiyer
Keyword(s):  
Risk Factors ◽  
Periprosthetic Joint Infection ◽  
Joint Infection ◽  
Patient Characteristics ◽  
Total Ankle Replacement ◽  
Orthopaedic Surgeons ◽  
Ankle Replacement ◽  
Increased Risk ◽  
Duration Of Surgery ◽  
Preoperative Patient

Category: Ankle, Ankle Arthritis Introduction/Purpose: A major complication of total ankle replacement (TAR) is a periprosthetic joint infection (PJI). The reported rate of this complication ranges between 2.4 – 8.9%. Identifying preoperative patient characteristics that correlate with an increased risk of PJI is of great interest to orthopaedic surgeons, as this may assist with appropriate patient selection. The purpose of this study is to systematically review the literature to identify risk factors that are associated with PJI following TAR. Methods: Utilizing the terms “(risk factor OR risk OR risks) AND (infection OR infected) AND (ankle replacement OR ankle arthroplasty)” we searched the PubMed/MEDLINE electronic databases. Using the PRISMA guidelines, studies were selected for inclusion if they assessed clinical risk factors for developing a PJI following TAR. In addition, the reference lists of included studies were also reviewed and compared to the collected studies to ensure that no pertinent papers were omitted. The quality of the included studies was then assessed using the American Academy of Orthopaedic Surgeons Clinical Practice Guideline and Systematic Review Methodology. Recommendations were made using the overall strength of evidence. Results: Eight studies met the inclusion criteria, totaling 12,704 patients who underwent a TAR. A limited strength of recommendation can be made that the following preoperative patient characteristics correlate with an increased risk of PJI following TAR: inflammatory arthritis, prior ankle surgery, age greater than 65 years, body mass index less than 19, peripheral vascular disease, chronic lung disease, hypothyroidism, and low preoperative AOFAS hindfoot scores. There is conflicting evidence in the literature regarding the effect of obesity, tobacco use, diabetes, and duration of surgery. Conclusion: Several risk factors were identified as having an association with PJI following TAR. These factors may alert surgeons that a higher rate of PJI is possible. However, because of the low level of evidence of reported studies, only a limited strength of recommendation can be ascribed to regard these as risk factors for PJI at this time.

scholarly journals Validation of revision data for total hip and knee replacements undertaken at a high volume orthopaedic centre against data held on the National Joint Registry

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Irrum Afzal ◽  
Sarkhell Radha ◽  
Tomislav Smoljanović ◽  
Giles H. Stafford ◽  
Roy Twyman ◽  
...  
Keyword(s):  
Data Entry ◽  
High Volume ◽  
Tissue Reaction ◽  
National Joint Registry ◽  
Total Hip ◽  
Joint Registry ◽  
Knee Replacements ◽  
Hip Replacements ◽  
Particulate Debris ◽  
The Uk

Abstract Background With over 2.35 million records, the National Joint Registry (NJR) is the largest arthroplasty registry in the world. It provides a powerful tool to monitor implant survivorship and influence different surgical strategies. To date, little work has been undertaken to investigate the validity of the ‘Reason for Revision’ recorded in Consultant Outcome Reports on the NJR. Methods The NJR was queried to identify all revisions on the THR performed at a single centre over an 11-year period. Review and validation of ‘Reason for Revision’ for each case was undertaken using radiological imaging studies, pathology, histology, microbiology and electronic medical records. Results Of the 22,046 primary total hip replacements (THR) and total knee replacements (TKR) undertaken by 23 surgeons at our hospital, over an 11-year period, 1.35% (297) were subsequently reported to the NJR as revised. Discrepancies in reporting to the NJR were identified for 41 cases (25.63%) for THR and 28 (20.40%) cases for TKR. Revision for infection was under-reported for both THR and TKR by 1.88% and 3.65% respectively. Reporting of adverse soft tissue reaction to particulate debris for THR was unreported by 11%. Progressive arthritis following a TKR was unreported by 6.56%. All the cases reported as ‘other’ (8.75% for THRs and 3.65% for TKRs) were reclassified to the most appropriate ‘reason for revision’ category. The ‘reason for revision’ data is recorded to the NJR with findings at the time of surgery. It is some days before microbiology and histology reports become available and source data is not always updated. Conclusion If an average of 23% wrong data entry at a highly organised institution is replicated throughout the UK, a formal process to validate primary and revision data submitted to the NJR should be considered. Local scrutiny, review and validation of revision data are all vital to optimise the value of the NJR. Accurate data recorded to the NJR is imperative to provide safe and effective improvements in orthopaedic surgery.

scholarly journals A data linkage study of suspected seizures in the urgent and emergency care system in the UK

2020 ◽  
Vol 37 (10) ◽  
pp. 605-610
Author(s):  
Thomas Hughes-Gooding ◽  
Jon M Dickson ◽  
Colin O'Keeffe ◽  
Suzanne M Mason
Keyword(s):  
Emergency Care ◽  
Data Linkage ◽  
Models Of Care ◽  
Linkage Study ◽  
Adverse Outcomes ◽  
Published Data ◽  
Full Potential ◽  
Cross Sectional ◽  
Using Data ◽  
The Uk

IntroductionThe urgent and emergency care (UEC) system is struggling with increased demand, some of which is clinically unnecessary. Patients suffering suspected seizures commonly present to EDs, but most seizures are self-limiting and have low risk of short-term adverse outcomes. We aimed to investigate the flow of suspected seizure patients through the UEC system using data linkage to facilitate the development of new models of care.MethodsWe used a two-stage process of deterministic linking to perform a cross-sectional analysis of data from adults in a large region in England (population 5.4 million) during 2014. The core dataset comprised a total of 739 436 ambulance emergency incidents, 1 033 778 ED attendances and 362 358 admissions.ResultsA high proportion of cases were successfully linked (86.9% ED-inpatient, 77.7% ED-ambulance). Suspected seizures represented 2.8% of all ambulance service incidents. 61.7% of these incidents led to dispatch of a rapid-response ambulance (8 min) and 72.1% were conveyed to hospital. 37 patients died before being conveyed to hospital and 24 died in the ED (total 61; 0.3%). The inpatient death rate was 0.4%. Suspected seizures represented 0.71% of ED attendances, 89.8% of these arrived by emergency ambulance, 45.4% were admitted and 44.5% of these admissions lasted under 48 hours.ConclusionsThis study confirms previously published data from smaller unlinked datasets, validating the linkage method, and provides new data for suspected seizures. There are significant barriers to realising the full potential of data linkage. Collaborative action is needed to create facilitative governance frameworks and improve data quality and analytical capacity.

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