ORTHOPEDIC SURGERY AMONG THE ELDERLY: CLINICAL CHARACTERISTICS

Mind Health Before and After Total Knee Arthroplasty

Objective  To assess the preoperative and postoperative outcomes of patients diagnosed with severe knee osteoarthritis who underwent a total knee arthroplasty (TKA) using a mobile-bearing implant with a rotating platform and removing the posterior cruciate ligament. The present study focused on the outcomes relative to depression, pain, functional limitations, and fall episodes. Methods  The Lequesne questionnaire was used to assess pain and functional limitations before and after TKA. In addition, the geriatric depression scale (GDS) was also used. Episodes of falls before and after the surgery were estimated. Results  The mean Lequesne score before the surgery was 15.95, and that after surgery was 6.5. This finding was statistically significant ( p  < 0.001). The mean GDS score before the surgery was 7.43, and that after TKA was 2.22 ( p  < 0.001). The mean number of fall occurrences before the procedure, over a 1-year period, was 1.22, and that after TKA was 0.27 ( p  = 0.004). A direct relationship was found between the Lequesne scores before the surgery and the GDS scores ( p  = 0.004). Conclusions  Total knee arthroplasty resulted in the improvement of pain and functional limitation, decrease or disappearance of the depressive condition, and decrease of fall rates in the evaluated patients.

An audit of admissions and mortality of orthopedic indoor patients in a tertiary care hospital of India

INTRODUCTION

Mortality in orthopaedics is different in underdeveloped, developing and developed countries depending on the health, orthopaedic and trauma care services, education status and social awareness. Analysis of mortality and causes of death is an important step to identify the risk factor. Such study is invaluable for epidemiological monitoring and health care planning.

METHODS

Between September 2015 to August 2018 demographic data, timing and primary diagnosis of both mortality and admission were collected retrospectively in a leading tertiary care hospital in the city of Mumbai, India.

RESULTS

Total admissions of 10,937 in the 3-year period with increased average monthly admission in the month of June, July and August. Trauma to be most common cause of admission and death and Road traffic accident to be the most common cause of trauma followed by slip and fall. The death rate was 0.55 per 100 admissions per year. In males most common age group was 18-60 years and in females above 60 years of age.

CONCLUSION

There is a link of increased admission rate in the monsoon months (rainy season) in India and road traffic accident and slip and fall. So accident prevention and health care planning and management of trauma victim, improvement of quality of life of general population will reduce trauma and related complications.

HIGHER RISK OF COMPLICATIONS AFTER TOTAL KNEE ARTHROPLASTY IN OCTOGENARIANS

Objective:

To evaluate the complication rate of total knee arthroplasty (TKA) in octogenarian patients and identify predictive factors.

Methods:

The study comprised 70 octogenarians and 70 non-octogenarian patients as control group, all submitted to TKA. We analyzed the medical records of these patients, seeking for complications during the first postoperative year. Regarding the risk factors, we evaluated: age, sex, race, American Society of Anesthesiologists score, body mass index, smoking, hypertension and diabetes mellitus.

Results:

In the control group, the incidence of complications was 7.1%. Whereas in the octogenarian group it was significantly higher, reaching 34.3% (OR 6.8; 95% CI 2.4-19.1). We found no association to sex, skin color, and comorbidities. Age is an independent risk factor for postoperative complications. Our data may help patients to acknowledge the risks of undergoing primary TKA and physicians to assess and adjust perioperative risk.

Conclusion:

The incidence of postoperative complications is significantly higher in octogenarians. Level of Evidence III, Case-control study.

Comorbidities, clinical intercurrences, and factors associated with mortality in elderly patients admitted for a hip fracture

Objective

To analyze comorbidities and clinical complications, and to determine the factors associated with mortality rates of elderly patients admitted with a hip fracture in a tertiary public hospital.

Methods

Sixty-seven medical records were reviewed in a retrospective cohort study, including patients equal to or older than 65 years admitted to this institution for hip fracture between January 2014 and December 2014. The evaluated items constituted were the following: interval of time between fracture and hospital admission, time between admission and surgical procedure, comorbidities, clinical complications, type of orthopedic procedure, surgical risk, cardiac risk, and patient outcome.

Results

The average patients’ age in the sample was 77.6 years, with a predominance of the female gender. Most patients (50.7%) had two or more comorbidities. The main clinical complications during hospitalization included cognitive behavioral disorders, respiratory infection and of the urinary tract. The times between fracture and admission and between admission and surgery were more than seven days in most of cases. The mortality rate during hospitalization was 11.9%, and was directly connected to the presence of infections during hospital stay (p = 0.006), to time between admission and surgery longer than seven days (p = 0.005), to the Goldman Cardiac Risk Index class III (p = 0.008), and to age equal to or greater than 85 years (p = 0.031).

Conclusion

Patients with hip fractures generally present comorbidities, are susceptible to clinical complications, and have an 11.9% mortality rate.