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Mancino F, Wall B, Bucher TA, Prosser GH, Yates PJ, Jones CW. Treatment strategy and clinical outcomes of surgically managed hip periprosthetic fractures: analysis from a high-volume centre. Hip Int 2024:11207000241256873. [PMID: 38860688 DOI: 10.1177/11207000241256873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/12/2024]
Abstract
BACKGROUND Hip periprosthetic fractures (PPF) after total hip arthroplasty (THA) are becoming increasingly prevalent. Their management is secondary to the fracture type and the stability of the implant. This study aimed to provide the outcomes of operatively managed PPF from a high-volume centre to help guide future decision making. METHODS This was a retrospective study of prospectively collected data from January 2008 to January 2021. Patient demographics, implant specific details, and fixation strategy were collected. Complications including infection, reoperation, re-fracture, re-revision, were collected. Short-term mortality was evaluated at 3 months and 1 year. P-values <0.05 were considered significant. RESULTS 282 surgically managed PPF were identified. Vancouver B2 were predominant in 52% of the cases. Revision alone and revision with additional fixation were the most frequent strategies in 168 cases (60%). Complications requiring reoperation occurred in 20% of the cases, with infection as the most frequent (8.5%). Mortality rate was 7.8% at 3 months and 15.7% at 1 year, with significantly lower rates in B2 type. B2 fractures treated with cemented stems had a significantly lower 1-year mortality than distal fit revisions. CONCLUSIONS PPF is associated with a high complication rate. Revision alone and revision with additional fixation remain the preferred method in B2/B3 type fractures, however, cemented revision can yield similar outcomes with lower short-term mortality. Considering the high-risk elderly and frail category of patients, a multidisciplinary team is necessary to improve outcomes and reduce mortality.
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Affiliation(s)
- Fabio Mancino
- Department of Orthopaedics, Fiona Stanley Hospital, Perth, WA, Australia
- The Orthopaedic Research Foundation of Western Australia (ORFWA), Perth, WA, Australia
| | - Ben Wall
- Department of Orthopaedics, Fiona Stanley Hospital, Perth, WA, Australia
| | - Thomas A Bucher
- Department of Orthopaedics, Fiona Stanley Hospital, Perth, WA, Australia
| | - Gareth H Prosser
- Department of Orthopaedics, Fiona Stanley Hospital, Perth, WA, Australia
| | - Piers J Yates
- Department of Orthopaedics, Fiona Stanley Hospital, Perth, WA, Australia
- The Orthopaedic Research Foundation of Western Australia (ORFWA), Perth, WA, Australia
- University of Western Australia, Perth, WA, Australia
| | - Christopher W Jones
- Department of Orthopaedics, Fiona Stanley Hospital, Perth, WA, Australia
- The Orthopaedic Research Foundation of Western Australia (ORFWA), Perth, WA, Australia
- Curtin University, Perth, WA, Australia
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2
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Garala K, Remtulla MA, Verma R, Lawrence T. Cemented acetabular components combined with trabecular metal augments provide excellent long-term survivorship for severe acetabular bone loss. Hip Int 2023; 33:833-838. [PMID: 35658637 DOI: 10.1177/11207000221102848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Acetabular bone loss is a challenging problem for revision hip surgeons. This study aimed to explore long-term outcomes of patients who have undergone cemented acetabular revision in conjunction with trabecular metal augmentation and impaction bone grafting in cases with significant segmental bone loss. METHODS All patients who underwent cemented acetabular revision requiring impaction bone grafting and trabecular metal augments with a minimum Paprosky score of 2B and minimum follow up of 5 years were identified. Pre- and postoperative WOMAC scores were compared. An assessment of pre- and postoperative hip centre of rotation was performed and compared to native centre of rotation. Immediate postoperative centre of rotation was then compared to radiographs at latest follow up to measure for migration of acetabular components. RESULTS 42 patients were identified. Mean age was 53 years old with 7 males and 35 female patients. Mean follow-up was 9.5 years. Preoperative WOMAC score was 30 and there was an increase to 90 (p < 0.01) at latest follow-up. No hips were revised for loosening or infection. There was a mean improvement in centre of rotation of 6.80 mm (CI, 4.57-9.03 mm) which was significant (p < 0.00002). There was no change of position of centre of rotation from immediate postoperative radiographs and those at latest follow up (p = 0.3). CONCLUSIONS Cemented acetabular components work well in conjunction with trabecular metal augments and impacted bone grafts in reconstructing complex acetabular defects. Together they provide immediate and long-term component stability, with excellent long-term clinical and radiological outcomes.
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Affiliation(s)
- Kanai Garala
- University Hospitals Birmingham - Solihull Hospital, Solihull, UK
| | | | - Raghav Verma
- University Hospitals Birmingham - Solihull Hospital, Solihull, UK
| | - Trevor Lawrence
- University Hospitals Birmingham - Solihull Hospital, Solihull, UK
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3
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Bloch BV, White JJE, Matar HE, Berber R, Manktelow ARJ. Should patient age thresholds dictate fixation strategy in total hip arthroplasty? Bone Joint J 2022; 104-B:206-211. [PMID: 35094580 DOI: 10.1302/0301-620x.104b2.bjj-2021-1199.r1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Total hip arthroplasty (THA) is a very successful and cost-effective operation, yet debate continues about the optimum fixation philosophy in different age groups. The concept of the 'cementless paradox' and the UK 'Getting it Right First Time' initiative encourage increased use of cemented fixation due to purported lower revision rates, especially in elderly patients, and decreased cost. METHODS In a high-volume, tertiary referral centre, we identified 10,112 THAs from a prospectively collected database, including 1,699 cemented THAs, 5,782 hybrid THAs, and 2,631 cementless THAs. The endpoint was revision for any reason. Secondary analysis included examination of implant survivorship in patients aged over 70 years, over 75 years, and over 80 years at primary THA. RESULTS Cemented fixation had the lowest implant survival in all age groups, with a total ten-year survivorship of 97.0% (95% confidence interval (CI) 95.8 to 97.8) in the cemented group, 97.6% (95% CI 96.9 to 98.1) in the hybrid group, and 97.9% (95% CI 96.9 to 98.6) in the cementless group. This was not statistically significant (p = 0.092). There was no age group where cemented fixation outperformed hybrid or cementless fixation. CONCLUSION While all fixation techniques performed well at long-term follow-up, cemented fixation was associated with the lowest implant survival in all age groups, including in more elderly patients. We recommend that surgeons should carefully monitor their own outcomes and use fixation techniques that they are familiar with, and deliver the best outcomes in their own hands. Cite this article: Bone Joint J 2022;104-B(2):206-211.
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Affiliation(s)
- Benjamin V Bloch
- Nottingham Elective Orthopaedic Services, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Jonathan J E White
- Nottingham Elective Orthopaedic Services, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Hosam E Matar
- Nottingham Elective Orthopaedic Services, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Reshid Berber
- Nottingham Elective Orthopaedic Services, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Andrew R J Manktelow
- Nottingham Elective Orthopaedic Services, Nottingham University Hospitals NHS Trust, Nottingham, UK
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4
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Veldman HD, de Bot RTAL, Heyligers IC, Boymans TAEJ, Hiligsmann M. Cost-effectiveness analyses comparing cemented, cementless, hybrid and reverse hybrid fixation in total hip arthroplasty: a systematic overview and critical appraisal of the current evidence. Expert Rev Pharmacoecon Outcomes Res 2021; 21:579-593. [PMID: 33472442 DOI: 10.1080/14737167.2021.1878880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Background: This study aims to present an overview and critical appraisal of all previous studies comparing costs and outcomes of the different modes of fixation in total hip arthroplasty (THA). A secondary aim is to provide conclusions regarding the most cost-effective mode of implant fixation per gender and age-specific population in THA, based on high quality studies.Methods: A systematic search was conducted to identify cost-effectiveness analyses (CEAs) comparing different modes of implant fixation in THA. Analysis of results was done with solely CEAs that had a high methodological quality.Results: A total of 12 relevant studies were identified and presented, of which 5 were considered to have the methodological rigor for inclusion in the analysis of results. These studies found that either cemented or hybrid fixation was the most cost-effective implant fixation mode for most age- and gender-specific subgroups.Conclusion: Currently available well performed CEAs generally support the use of cemented and hybrid fixation for all age-groups relevant for THA and both genders. However, these findings were mainly based on a single database and depended on assumptions made in the studies' methodology. Issues discussed in this paper have to be considered and future work is needed.
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Affiliation(s)
- H D Veldman
- Zuyderland Medical Center, Dept. Of Orthopaedic Surgery and Traumatology, Heerlen, The Netherlands.,Care and Public Health Research Institute (CAPHRI), Maastricht University, Dept. Of Health Services Research, Maastricht, The Netherlands
| | - R T A L de Bot
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Dept. Of Health Services Research, Maastricht, The Netherlands.,Maastricht University Medical Center, dept. of Orthopaedics, Maastricht, The Netherlands
| | - I C Heyligers
- Zuyderland Medical Center, Dept. Of Orthopaedic Surgery and Traumatology, Heerlen, The Netherlands.,School of Health Professions Education (SHE), Maastricht University, Maastricht, The Netherlands
| | - T A E J Boymans
- Maastricht University Medical Center, dept. of Orthopaedics, Maastricht, The Netherlands
| | - M Hiligsmann
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Dept. Of Health Services Research, Maastricht, The Netherlands
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5
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Pley C, Purohit K, Krkovic M, Abdulkarim A. A health economic analysis of the management of open lower limb fractures in the elderly. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2020; 30:1383-1391. [PMID: 32519071 PMCID: PMC7680339 DOI: 10.1007/s00590-020-02713-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 05/31/2020] [Indexed: 11/16/2022]
Abstract
AIM The aim of this study was to investigate the financial implications of the inpatient management of open lower limb fractures in adults over 65 years old. Further, the study compares the calculated cost to the income received by the hospital for these patients and to the existing body of literature. METHODS This study employed direct inpatient costing analysis to estimate the cost of treating the open lower limb fractures incurred by 58 patients over the age of 65 years treated in our centre (Addenbrooke's Hospital, Cambridge University Hospitals NHS Trust) between March 2014 and March 2019. RESULTS The median cost of inpatient care calculated in this study was £20,398 per patient, resulting in a financial loss to the hospital of £5113 per patient. When the results were disaggregated by sex, the median cost for an open lower limb fracture in a male patient was £20,886 compared to £19,304 in a female patient. Data were also disaggregated by the site of injury, which produced a median cost for an open femur fracture of £23,949, and £24,549 and £15,362 for open tibia and ankle fractures, respectively. CONCLUSION This study provides a valuable estimate of the expense of treating open lower limb fractures in patients over the age of 65 years in a Major Trauma Centre in England. The study highlights the large losses incurred by hospitals in treating these cases, and supports revision of the remuneration structures in the National Health Service to adequately cover their cost.
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Affiliation(s)
- Caitlin Pley
- School of Clinical Medicine, University of Cambridge, Cambridge, UK.
| | - Katie Purohit
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
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Blankstein M, Lentine B, Nelms NJ. The Use of Cement in Hip Arthroplasty: A Contemporary Perspective. J Am Acad Orthop Surg 2020; 28:e586-e594. [PMID: 32692094 DOI: 10.5435/jaaos-d-19-00604] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Notable advances in hip arthroplasty implants and techniques over the past 60 years have yielded excellent survivorship of fully cemented, hybrid, and reverse hybrid total hip replacements as demonstrated in joint registries worldwide. Major advances in noncemented implants have reduced the use of cement, particularly in North America. Noncemented implants predominate today based on procedural efficiency, concern related to thromboembolic risk, and a historic belief that cement was the primary cause of osteolysis and implant loosening. With the decline of cemented techniques, press-fit fixation has become common even in osteoporotic elderly patients. Unfortunately, there is a troubling rise in intraoperative, as well as early and late postoperative periprosthetic fractures associated with the use of noncemented implants. Despite the success of noncemented fixation, an understanding of modern cement techniques and cemented implant designs is useful to mitigate the risk of periprosthetic fractures. Cemented acetabular components can be considered in elderly patients with osteoporotic or pathologic bone. Cemented stems should be considered with abnormal proximal femoral morphology, conversion of failed hip fixation, inflammatory arthritis, patient age over 75 (especially women), osteoporotic bone (Dorr C), and in the treatment of femoral neck fractures.
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Affiliation(s)
- Michael Blankstein
- From the The University of Vermont Medical Center, Orthopedics and Rehabilitation Center (Dr. Blankstein and Dr. Nelms), and the Department of Orthopaedics and Rehabilitation (Dr. Lentine), The Robert Larner, M.D., College of Medicine at The University of Vermont, Burlington, VT
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7
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Shah RF, Bini S, Vail T. Data for registry and quality review can be retrospectively collected using natural language processing from unstructured charts of arthroplasty patients. Bone Joint J 2020; 102-B:99-104. [DOI: 10.1302/0301-620x.102b7.bjj-2019-1574.r1] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims Natural Language Processing (NLP) offers an automated method to extract data from unstructured free text fields for arthroplasty registry participation. Our objective was to investigate how accurately NLP can be used to extract structured clinical data from unstructured clinical notes when compared with manual data extraction. Methods A group of 1,000 randomly selected clinical and hospital notes from eight different surgeons were collected for patients undergoing primary arthroplasty between 2012 and 2018. In all, 19 preoperative, 17 operative, and two postoperative variables of interest were manually extracted from these notes. A NLP algorithm was created to automatically extract these variables from a training sample of these notes, and the algorithm was tested on a random test sample of notes. Performance of the NLP algorithm was measured in Statistical Analysis System (SAS) by calculating the accuracy of the variables collected, the ability of the algorithm to collect the correct information when it was indeed in the note (sensitivity), and the ability of the algorithm to not collect a certain data element when it was not in the note (specificity). Results The NLP algorithm performed well at extracting variables from unstructured data in our random test dataset (accuracy = 96.3%, sensitivity = 95.2%, and specificity = 97.4%). It performed better at extracting data that were in a structured, templated format such as range of movement (ROM) (accuracy = 98%) and implant brand (accuracy = 98%) than data that were entered with variation depending on the author of the note such as the presence of deep-vein thrombosis (DVT) (accuracy = 90%). Conclusion The NLP algorithm used in this study was able to identify a subset of variables from randomly selected unstructured notes in arthroplasty with an accuracy above 90%. For some variables, such as objective exam data, the accuracy was very high. Our findings suggest that automated algorithms using NLP can help orthopaedic practices retrospectively collect information for registries and quality improvement (QI) efforts. Cite this article: Bone Joint J 2020;102-B(7 Supple B):99–104.
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Affiliation(s)
- Romil F. Shah
- Department of Orthopedic Surgery, University of California - San Francisco, San Francisco, California, USA
| | - Stefano Bini
- Department of Orthopedic Surgery, University of California - San Francisco, San Francisco, California, USA
- Department of Orthopedic Surgery, University of Texas at Austin, Austin, Texas, USA
| | - Thomas Vail
- Department of Orthopedic Surgery, University of California - San Francisco, San Francisco, California, USA
- Department of Orthopedic Surgery, University of Texas at Austin, Austin, Texas, USA
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8
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Hoang-Kim A, Kanengisser D. Developing Registries and Effective Care Models for the Management of Hip Fractures: Aligning Political, Organizational Drivers with Clinical Outcomes. Curr Osteoporos Rep 2020; 18:180-188. [PMID: 32242305 DOI: 10.1007/s11914-020-00582-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The aim of the review is to conduct a literature search on cost-effectiveness or cost savings of osteoporosis fracture liaison services. RECENT FINDINGS We identified four types of FLS. A total of 11 cost-effectiveness studies examining 15 models of secondary fracture prevention models were identified. Nine models were found to be cost-saving, and five were found to be cost-effective. It is possible to adopt a cost-effective model for fracture liaison services and expand across geographical regions. Adopting registries can have the added benefit of monitoring quality improvement practices and treatment outcomes. Challenges exist in implementing registries where centralized data collections across different chronic conditions are politically driving agendas. In order to align political and organizational strategic plans, a core set of outcome evaluations that are both focused on patient and provider experience in addition to treatment outcomes can be a step toward achieving better health and services.
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Affiliation(s)
- Amy Hoang-Kim
- Dalla Lana School of Public Health, Institute of Health, Policy, Management and Evaluation, University of Toronto, 155 College Street, Toronto, Ontario, Canada.
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9
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Van Praet F, Mulier M. To cement or not to cement acetabular cups in total hip arthroplasty: a systematic review and re-evaluation. SICOT J 2019; 5:35. [PMID: 31571579 PMCID: PMC6771226 DOI: 10.1051/sicotj/2019032] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 08/22/2019] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Total Hip Arthroplasty (THA) in the treatment of primary osteoarthritis of the hip has evolved to a very safe and cost-effective intervention with revision rates below 5% after 10 years. To this day, however, controversy remains on whether or not to cement the acetabular cup. METHODS A comprehensive PubMed search of the English literature for studies published between 2007 and 2018 was performed. Studies comparing the clinical (revision rate, functionality), radiological (wear) or economic (cost) differences between cemented (cemented stem with cemented cup) and hybrid (cemented stem with uncemented cup) prostheses for primary osteoarthritis of the hip were identified as eligible. RESULTS A total of 1032 studies were identified whereof twelve were included for qualitative synthesis. All studies concerning the risk of revision were based on registry data, covering a total of 365,693 cups. Cemented prostheses had a similar or lower risk of revision compared to hybrid prostheses in every study, but performed slightly worse on functionality and quality of life. While cemented prostheses were the cheapest option, hybrids were the most cost-effective. DISCUSSION The widespread preference for cementless fixation of the acetabulum cannot be explained by a superior survival of cementless or hybrid models. Irrespective of age, cemented fixation of the acetabulum remains the gold standard to which other techniques should be compared.
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Affiliation(s)
- Frank Van Praet
- Master of Medicine, KU Leuven, Bergsken 50, 9310 Moorsel, Belgium
| | - Michiel Mulier
- Department of Development and Regeneration, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
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10
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Funk GA, Menuey EM, Cole KA, Schuman TP, Kilway KV, McIff TE. Radical scavenging of poly(methyl methacrylate) bone cement by rifampin and clinically relevant properties of the rifampin-loaded cement. Bone Joint Res 2019; 8:81-89. [PMID: 30915214 PMCID: PMC6397418 DOI: 10.1302/2046-3758.82.bjr-2018-0170.r2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Objectives The objective of this study was to characterize the effect of rifampin incorporation into poly(methyl methacrylate) (PMMA) bone cement. While incompatibilities between the two materials have been previously noted, we sought to identify and quantify the cause of rifampin’s effects, including alterations in curing properties, mechanical strength, and residual monomer content. Methods Four cement groups were prepared using commercial PMMA bone cement: a control; one with 1 g of rifampin; and one each with equimolar amounts of ascorbic acid or hydroquinone relative to the amount of rifampin added. The handling properties, setting time, exothermic output, and monomer loss were measured throughout curing. The mechanical strength of each group was tested over 14 days. A radical scavenging assay was used to assess the scavenging abilities of rifampin and its individual moieties. Results Compared with control, the rifampin-incorporated cement had a prolonged setting time and a reduction in exothermic output during polymerization. The rifampin cement showed significantly reduced strength and was below the orthopaedic weight-bearing threshold of 70 MPa. Based on the radical scavenging assay and strength tests, the hydroquinone structure within rifampin was identified as the polymerization inhibitor. Conclusion The incorporation of rifampin into PMMA bone cement interferes with the cement’s radical polymerization. This interference is due to the hydroquinone moiety within rifampin. This combination alters the cement’s handling and curing properties, and lowers the strength below the threshold for weight-bearing applications. Additionally, the incomplete polymerization leads to increased toxic monomer output, which discourages its use even in non-weight-bearing applications. Cite this article: G. A. Funk, E. M. Menuey, K. A. Cole, T. P. Schuman, K. V. Kilway, T. E. McIff. Radical scavenging of poly(methyl methacrylate) bone cement by rifampin and clinically relevant properties of the rifampin-loaded cement. Bone Joint Res 2019;8:81–89. DOI: 10.1302/2046-3758.82.BJR-2018-0170.R2.
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Affiliation(s)
- G A Funk
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - E M Menuey
- Department of Chemistry, University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - K A Cole
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - T P Schuman
- Department of Chemistry, Missouri University of Science and Technology, Rolla, Missouri, USA
| | - K V Kilway
- Department of Chemistry, University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - T E McIff
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
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11
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Caraan NA, Windhager R, Webb J, Zentgraf N, Kuehn KD. Role of fast-setting cements in arthroplasty: A comparative analysis of characteristics. World J Orthop 2017; 8:881-890. [PMID: 29312846 PMCID: PMC5745430 DOI: 10.5312/wjo.v8.i12.881] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 10/09/2017] [Accepted: 11/08/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate the behaviour of two fast-setting polymethylmethacrylate (PMMA) cements CMW® 2G and Palacos® fast R + G, as reference: Standard-setting Palacos® R + G.
METHODS The fast-setting cements CMW® 2G and Palacos® fast R + G were studied, using standard-setting high viscosity Palacos® R + G as a reference. Eleven units (of two batch numbers) of each cement were tested. All cements were mixed as specified by the manufacturer and analysed on the following parameters: Handling properties (mixing, waiting, working and hardening phase) according to Kuehn, Mechanical properties according to ISO 5833 and DIN 53435, Fatigue strength according to ISO 16402, Benzoyl Peroxide (BPO) - Content by titration, powder/liquid-ratio by weighing, antibiotic elution profile by High Performance Liquid Chromatography. All tests were done in an acclimatised laboratory with temperatures set at 23.5 °C ± 0.5 °C and a humidity of > 40%.
RESULTS Palacos® fast R + G showed slightly shorter handling properties (doughing, hardening phase, n = 12) than CMW® 2G, allowing to reduce operative time and to optimise cemented cup implantation. Data of the quasistatic properties of ISO 5833 and DIN 53435 of both cements tested was comparable. The ISO compressive strength (MPa) of Palacos® fast R + G was significantly higher than CMW® 2G, resulting in ANOVA (P < 0.01) and two sample t-test (P < 0.01) at 0.05 level of significance (n = 20). Palacos® fast R + G showed a higher fatigue strength of about 18% mean (ISO 16402) of 15.3 MPa instead of 13.0 MPa for CMW® 2G (n = 5 × 106 cycles). Palacos® fast R + G and CMW® 2G differed only by 0.11% (n = 6) with the former having the higher content. The BPO-content of both cements were therefore comparable. CMW® 2G had a powder/liquid ratio of 2:1, Palacos® fast R + G of 2.550:1 due to a higher powder content. Despite its higher gentamicin content, CMW® 2G showed a significantly lower antibiotic elution over time than Palacos® fast R + G (n = 3).
CONCLUSION Both cements are compliant with international standards and are highly suitable for their specified surgical indications, affording a time-saving measure without detriment to the mechanical properties.
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Affiliation(s)
- Neil Ayron Caraan
- Department of Orthopaedics and Orthopaedic Surgery, Medical University of Vienna, Vienna 1090, Austria
| | - Reinhard Windhager
- Department of Orthopaedics and Orthopaedic Surgery, Medical University of Vienna, Vienna 1090, Austria
| | - Jason Webb
- Avon Orthopaedic Centre, North Bristol NHS Trust, Southmead Hospital, Bristol BS10 5NB, United Kingdom
| | - Nadine Zentgraf
- Heraeus Medical GmbH, Wehrheim 61273, Germany
- Medical University of Vienna, Vienna 1090, Austria
| | - Klaus-Dieter Kuehn
- Heraeus Medical GmbH, Wehrheim 61273, Germany
- Medical University of Vienna, Vienna 1090, Austria
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12
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Tissingh EK, Memarzadeh A, Queally J, Hull P. Open lower limb fractures in Major Trauma Centers - A loss leader? Injury 2017; 48:353-356. [PMID: 28087118 DOI: 10.1016/j.injury.2016.12.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 12/06/2016] [Accepted: 12/21/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE Open lower limb fractures are resource intensive injuries. Regardless of the financing model, the cost of treatment is an important consideration for any healthcare provider. METHODS Open lower limb fractures treated at our centre were identified over a six-month period. Isolated open femur or tibia fractures were included as well as cases with multiple fractures. Direct inpatient care costs were calculated and income was reviewed for each case according to 'Healthcare Resource Group' (HRG) cost codes. RESULTS A total of 41 open lower limb fractures (32 patients) were identified. There were isolated open fractures in twenty-five and multiple lower limb open fractures in seven patients. Twenty-three patients (72%) were male and nine were female (28%) with an average age of 40 years (range 10-89 years). The fractures were classified according to Gustilo and Anderson (GA) and divided into two main groups; there were 13 mild and 28 severe open fractures. The median direct cost of inpatient treatment for open lower limb fractures was £19,189 per patient. There was a net gain of £6,288 per fracture in the mild group and a loss of £7,582 in the severe group. The total deficit was £149,545 over the six-month period for this cohort of 41 fractures. CONCLUSION Open lower limb fractures are expensive to treat at a cost of approximately £19,200 per patient and associated with a significant loss of income in our MTC. Cost codes should reflect the complex and more expensive treatment of these patients to avoid the inadvertent financial 'penalties' of treating such patients. This study is the first to calculate the direct inpatient treatment costs of open lower limb fractures in a major trauma centre. It highlights the need for cost saving strategies and for appropriate remuneration in MTCs.
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Affiliation(s)
| | | | | | - Peter Hull
- Addenbrooke's Hospital, Hills Road, Cambridge, UK
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A cemented cup with acetabular impaction bone grafting is more cost-effective than an uncemented cup in patients under 50 years. Hip Int 2017; 26:43-9. [PMID: 26743037 DOI: 10.5301/hipint.5000301] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/30/2015] [Indexed: 02/04/2023]
Abstract
PURPOSE Acetabular deficiencies in young patients can be restored in several ways during total hip arthroplasty. Currently, cementless cups are most frequently used. Impaction bone grafting of acetabular defects is a more biological approach, but is it cost-effective in young patients on the long term? METHODS We designed a decision model for a cost-utility analysis of a cemented cup with acetabular impaction bone grafting versus an uncemented cup, in terms of cost per quality-adjusted life year (QALY) for the young adult with acetabular bone deficiency, in need for a primary total hip arthroplasty. Outcome probabilities and effectiveness were derived from the Radboud University Nijmegen Medical Centre and the Norwegian Hip Register. Multiple sensitivity analyses were used to assess the contribution of the included variables in the model's outcome. RESULTS Cemented cups with impaction bone grafting were more cost-effective compared to the uncemented option in terms of costs per QALY. A scenario suggesting equal primary survival rates of both cemented and uncemented cups still showed an effect gain of the cemented cup with impaction bone grafting, but at higher costs. CONCLUSIONS Based on this model, the first choice of treatment of the acetabular bone deficient osteoarthritic hip in a young patient is reconstruction with impaction bone grafting and a cemented cup.
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Day of Surgery Admission in Total Joint Arthroplasty: Why Are Surgeries Cancelled? An Analysis of 3195 Planned Procedures and 114 Cancellations. Adv Orthop 2016; 2016:1424193. [PMID: 27974973 PMCID: PMC5128686 DOI: 10.1155/2016/1424193] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 10/18/2016] [Indexed: 11/23/2022] Open
Abstract
Background. Day of surgery admission (DOSA) is becoming standard practice as a means of reducing cost in total joint arthroplasty. Aims. The aim of our study was to audit the use of DOSA in a specialty hospital and identify reasons for cancellation. Methods. A retrospective study of patients presenting for hip or knee arthroplasty between 2008 and 2013 was performed. All patients were assessed at the preoperative assessment clinic (PAC). Results. Of 3195 patients deemed fit for surgery, 114 patients (3.5%) had their surgery cancelled. Ninety-two cancellations (80%) were due to the patient being deemed medically unsuitable for surgery by the anaesthetist. Cardiac disease was the most common reason for cancellation (n = 27), followed by pulmonary disease (n = 22). 77 patients (67.5%) had their operation rescheduled and successfully performed in our institution at a later date. Conclusion. DOSA is associated with a low rate of cancellations on the day of surgery. Patients with cardiorespiratory comorbidities are at greatest risk of cancellation.
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15
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Moskal JT, Capps SG, Scanelli JA. Still no single gold standard for using cementless femoral stems routinely in total hip arthroplasty. Arthroplast Today 2016; 2:211-218. [PMID: 28326430 PMCID: PMC5247516 DOI: 10.1016/j.artd.2016.02.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Revised: 02/01/2016] [Accepted: 02/08/2016] [Indexed: 11/28/2022] Open
Abstract
Background There is now a clear trend with increased usage of cementless femoral stems for all ages and most patients. As the number of total hip arthroplasties (THAs) performed annually continues to increase with expanding indications for THA and demands for improved quality of life, so will the prevalence of THA in the elderly and aging populations. This is worrisome as the risk of complications with cementless femoral stems increases in elderly patients and those with poor bone quality. The purpose of this study is to analyze the available data from comparative studies to determine whether cementless femoral stems are overused and whether cemented stems warrant increased consideration. Methods Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, searches were performed to find original studies comparing cementless and cemented femoral stems; large population registry studies and reports were also included. Results This systematic review documents that older patients with cementless fixation increase the risk of revision, there is no clear fixation advantage in midaged patients, and younger patients fare better with cementless fixation. Complications after THA create burdens on the health care system and on patients. Conclusions Using evidence-based data should be better guidance in selecting the most reliable implants for THA. Although cementless femoral fixation for THA has evolved to the “new standard,” it has not been proven to be the “gold standard” for all patients.
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Affiliation(s)
- Joseph T Moskal
- Department of Orthopaedic Surgery, Virginia Tech Carilion School of Medicine, Institute for Orthopaedics and Neurosciences at Carilion Clinic, Roanoke, VA, USA
| | | | - John A Scanelli
- The George Washington Medical Center, Washington Circle Orthopedic Associates, Washington, DC, USA
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16
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Hanstein T, Kumpe O, Mittelmeier W, Skripitz R. [Hybrid and uncemented hip arthroplasty: Contribution margin in the German lump sum reimbursement system]. DER ORTHOPADE 2016. [PMID: 26215628 DOI: 10.1007/s00132-015-3139-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND The economization of inpatient care began when lump sum reimbursement was introduced into the hospital sector. Since then, total hip arthroplasty (THA) has experienced a rapid development in terms of annual procedures and the optimization of the clinical pathway. Therefore, it is obvious to highlight THA as one of the most common procedures in the German health care system. In this work, the two most common techniques for the fixation of THA are investigated with regard to their cost structure and their influence on the clinical result. OBJECTIVES In Germany, uncemented and hybrid fixation are used for THA. In this study we investigated the differences in material costs, the duration of surgery, and the length of stay. MATERIALS AND METHODS For each fixation technique a retrospective cost analysis was carried out, based on the data from the treatment documentation of the University Hospital for Orthopedics, Rostock (OUK). The mean values of the parameters and expenses have been reviewed with descriptive statistics for differences. RESULTS With regard to total costs and the contribution margin there was no statistically significant difference. CONCLUSIONS Although there are differences in individual cost areas, in total costs, cost advantages and disadvantages cancel each other out. Thus, from an economic perspective no particular technique can be recommended.
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Affiliation(s)
- Tim Hanstein
- Hochschule Ludwigshafen am Rhein, Ernst-Boehe-Str. 4, 67059, Ludwigshafen am Rhein, Deutschland,
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17
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Busch V. The young osteoarthritic hip: Clinical outcome of total hip arthroplasty and a cost-effectiveness analysis. Acta Orthop 2015; 86:1-21. [PMID: 25898151 DOI: 10.3109/17453674.2015.1041354] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Affiliation(s)
- Vincent Busch
- Sint Maartenskliniek Orthopaedic surgery P.O. Box 9011, 6500 GM Nijmegen The Netherlands
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18
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Affiliation(s)
- G. M. Wright
- West Suffolk Hospital, Hardwick Lane, Bury St Edmunds, Suffolk IP33 2QZ, UK
| | - M. J. Porteous
- West Suffolk Hospital, Hardwick Lane, Bury St Edmunds, Suffolk IP33 2QZ, UK
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19
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Abstract
This review examines the future of total hip arthroplasty, aiming to avoid past mistakes
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Affiliation(s)
- A. Manktelow
- Nottingham University NHS Hospitals Trust, Hucknall Road, Nottingham NG5 1BP, UK
| | - B. Bloch
- Nottingham University NHS Hospitals Trust, Hucknall Road, Nottingham NG5 1BP, UK
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20
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Boyer P, Villain B, Pelissier A, Loriaut P, Dallaudière B, Massin P, Ravaud P, Ravaud P. Current state of anterior cruciate ligament registers. Orthop Traumatol Surg Res 2014; 100:879-83. [PMID: 25442050 DOI: 10.1016/j.otsr.2014.07.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Revised: 07/22/2014] [Accepted: 07/30/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this work was to report the main characteristics and results of all active anterior cruciate ligament (ACL) reconstruction registers along with the differences between them. METHODS We systematically searched on Google and Medline via PubMed to identify ACL registers. National or regional registers were included if they were active and took into account ACL reconstructions. The main results and characteristics, namely the number of inclusions, exhaustivity, data collection methods and results dissemination methods were determined. The collected information was then submitted to each register for validation. RESULTS Four registers (3 national, 1 regional) were identified that routinely included every ACL reconstruction procedure. Register data were collected either through dedicated websites or on paper forms. All the registers used the same two outcome measures, namely the revision rate and a subjective patient score (KOOS score). Register results were made available through scientific publications or annual reports. The main differences between registers were in the graft choice and presence of associated meniscus and cartilage injuries. CONCLUSIONS Although there are only a few ACL reconstruction-specific registers, their scientific contribution is undeniable thanks to the quality of the collected data and the organization and collaboration between registers. Their impact on health care and science should grow in the future.
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Affiliation(s)
- P Boyer
- Service de chirurgie orthopédique et traumatologique, université Paris Diderot, hôpital Bichat Claude-Bernard, Assistance publique-Hôpitaux de Paris, 46, rue Henri-Huchard, 75018 Paris, France; Inserm U738, université Paris Descartes, hôpital Hôtel-Dieu, Assistance publique-Hôpitaux de Paris, 1, place du parvis Notre-Dame, 75004 Paris, France.
| | - B Villain
- Service de chirurgie orthopédique et traumatologique, université Paris Diderot, hôpital Bichat Claude-Bernard, Assistance publique-Hôpitaux de Paris, 46, rue Henri-Huchard, 75018 Paris, France; Inserm U738, université Paris Descartes, hôpital Hôtel-Dieu, Assistance publique-Hôpitaux de Paris, 1, place du parvis Notre-Dame, 75004 Paris, France
| | - A Pelissier
- Service de chirurgie orthopédique et traumatologique, université Paris Diderot, hôpital Bichat Claude-Bernard, Assistance publique-Hôpitaux de Paris, 46, rue Henri-Huchard, 75018 Paris, France
| | - P Loriaut
- Service de chirurgie orthopédique et traumatologique, université Paris Diderot, hôpital Bichat Claude-Bernard, Assistance publique-Hôpitaux de Paris, 46, rue Henri-Huchard, 75018 Paris, France
| | | | - P Massin
- Service de chirurgie orthopédique et traumatologique, université Paris Diderot, hôpital Bichat Claude-Bernard, Assistance publique-Hôpitaux de Paris, 46, rue Henri-Huchard, 75018 Paris, France
| | - P Ravaud
- Inserm U738, université Paris Descartes, hôpital Hôtel-Dieu, Assistance publique-Hôpitaux de Paris, 1, place du parvis Notre-Dame, 75004 Paris, France
| | - P Ravaud
- Inserm U738, université Paris Descartes, hôpital Hôtel-Dieu, Assistance publique-Hôpitaux de Paris, 1, place du parvis Notre-Dame, 75004 Paris, France
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21
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Epinette JA, Asencio G, Essig J, Llagonne B, Nourissat C. Clinical results, radiological findings and survival of a proximally hydroxyapatite-coated hip ABG II stem at a minimum of ten years' follow-up: results of a consecutive multicentre study of 1148 hips in 1053 patients. Bone Joint J 2014; 95-B:1610-6. [PMID: 24293589 DOI: 10.1302/0301-620x.95b12.31167] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We report a multicentre prospective consecutive study assessing the long-term outcome of the proximally hydroxyapatite (HA)-coated ABG II monobloc femoral component in a series of 1148 hips in 1053 patients with a mean age at surgery of 64.77 years (22 to 80) at a mean follow-up of 10.84 years (10 to 15.25). At latest follow-up, the mean total Harris hip score was 94.7 points (sd; 6.87; 49 to 100), and the mean Merle d'Aubigné-Postel score was 17.6 points (sd 1.12; 7 to 18). The mean total Engh radiological score score was 21.54 (sd 5.77; 3.5 to 27), with 95.81% of 'confirmed ingrowth', according to Engh's classification. With aseptic loosening or pain as endpoints, three AGB II stems (0.26%) failed, giving a 99.7% survival rate (se 0.002; 95% confidence interval (CI) 0.994 to 1) at 14 years' follow-up. The survival of patients ≤ 50 years of age (99.0% (se 0.011; 95% CI 0.969 to 1)) did not differ significantly from those of patients aged > 50 years (99.8% (se 0.002; 95% CI 0.994 to 1)). This study confirmed the excellent long-term results currently achieved with the ABG II proximally HA-coated monobloc stem. Cite this article: Bone Joint J 2013;95-B:1610-16.
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Affiliation(s)
- J-A Epinette
- Clinique Médico-Chirurgicale, 200 Rue d'Auvergne, 62700 Bruay Labuissière, France
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22
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Affiliation(s)
- S. Konan
- University College London Hospitals NHS
Trust, Euston Road, London
NW1 2BU, UK
| | - F. S. Haddad
- University College London Hospitals NHS
Trust, Euston Road, London
NW1 2BU, UK
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23
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Kallala R, Anderson P, Morris S, Haddad FS. The cost analysis of cemented versus cementless total hip replacement operations on the NHS. Bone Joint J 2013; 95-B:874-6. [PMID: 23814235 DOI: 10.1302/0301-620x.95b7.26931] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
In a time of limited resources, the debate continues over which types of hip prosthesis are clinically superior and more cost-effective. Orthopaedic surgeons increasingly need robust economic evidence to understand the full value of the operation, and to aid decision making on the 'package' of procedures that are available and to justify their practice beyond traditional clinical preference. In this paper we explore the current economic debate about the merits of cemented and cementless total hip replacement, an issue that continues to divide the orthopaedic community.
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Affiliation(s)
- R Kallala
- University College London Hospital, 235 Euston Road, London NW1 2BU, UK
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24
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Affiliation(s)
- A. J. Timperley
- Princess Elizabeth Orthopaedic Centre, Royal
Devon and Exeter NHS Foundation Trust, Barrack Road, Exeter
EX2 5DW, UK
| | - F. S. Haddad
- The Bone & Joint Journal, 22 Buckingham Street, London WC2N 6ET, UK
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