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The article discusses the short-term outcomes and complications in obese patients undergoing hip and knee replacements. Complications for patients undergoing total joint replacement (TJR) will be difficult to determine if obesity is a risk factor for the conditions. Meanwhile, one of the problems in assessing outcomes after TJR is the improvement in pain and function from the index operation.

Background Magnetic resonance imaging ( MRI) is being increasingly utilized to define pathology and guide treatment in patients presenting with wrist pain. The clinical relevance of MRI identified or confirmed pathology has not been established, and the prevalence of asymptomatic MRI pathology is not known. Methods Twenty volunteers with no previous wrist injury or symptoms underwent bilateral MRI wrist studies in this exploratory diagnostic study. The scans were reported by an experienced musculoskeletal radiologist and an experienced wrist surgeon, with a consensus reached on each report. Results There were 3.15 positive MRI findings per wrist. There were 126 positive findings (range 1-6 per wrist). Sixty-eight ganglia were identified. Eleven ligament tears or perforations were also identified. Increased joint fluid was seen at many sites, most frequently adjacent to the piso-triquetral joint. Conclusion The accuracy of MRI in identifying triangular fibrocartilage complex tears, intercarpal ligament tears and carpal bone osteonecrosis is rapidly being refined. Positive MRI findings are common and may be coincidental in patients with wrist pain. MRI findings need to be correlated closely with clinical examination and history. [ABSTRACT FROM AUTHOR]

Introduction: Many infectious diseases display seasonal variation corresponding with particular conditions. In orthopaedics a growing body of evidence has identified surges in post‐operative infection rates during higher temperature periods. The aim of this research was to collate and synthesize the current literature on this topic. Methods: A systematic review and meta‐analysis was performed using five databases (PubMed, Embase, CINAHL, Web of Science and Central (Cochrane)). Study quality was assessed using the Grading of Recommendations Assessment, Development and Evaluation method. Odds ratios (ORs) were calculated from monthly infection rates and a pooled OR was generated using the DerSimonian and Lairds method. A protocol for this review was registered with the National Institute for Health Research International Prospective Register of Systematic Reviews (CRD42017081871). Results: Eighteen studies analysing over 19 000 cases of orthopaedic related infection met inclusion criteria. Data on 6620 cases and 9035 controls from 12 studies were included for meta‐analysis. The pooled OR indicated an overall increased odds of post‐operative infection for patients undergoing orthopaedic procedures during warmer periods of the year (pooled OR 1.16, 95% confidence interval 1.04–1.30). Conclusion: A small but significantly increased odds of post‐operative infection may exist for orthopaedic patients who undergo procedures during higher temperature periods. It is hypothesized that this effect is geographically dependent and confounded by meteorological factors, local cultural variables and hospital staffing cycles. [ABSTRACT FROM AUTHOR]

Background: The objective of routine outpatient assessment of well-functioning patients after primary total hip arthroplasty (THA) is to detect asymptomatic failure of prostheses to guide recommendations for early intervention. We have observed that the revision of THAs in asymptomatic patients is highly uncommon. We therefore question the need for routine follow-up of patients after THA. Methods: A prospective analysis of an orthopaedic database identified 158 patients who received 177 revision THAs over a four-year period. A retrospective chart review was conducted. Patient demographics, primary and revision surgery parameters and follow-up information were recorded and cross-referenced with Australian Orthopaedic Association National Joint Replacement Registry data. Results: One hundred ten THAs in 104 patients (average age 70.4 (SD 9.8 years)). There were 70 (63.6%) in total, 13 (11.8%) femoral and 27 (24.5%) acetabular revisions. The indications for revision were aseptic loosening (70%), dislocation (8.2%), peri-prosthetic fracture (7.3%), osteolysis (6.4%) and infection (4.5%). Only four (3.6%) were asymptomatic revisions. A mean of 5.3 (SD 5.2 and 1.9 (SD 5.3)) follow-up appointments were required before revision in patients with and without symptoms, respectively. The average time from the primary to revision surgery was 11.8 (SD 7.23) years. Conclusions: We conclude that patients with prostheses with excellent long-term clinical results as validated by joint registries, routine follow-up of asymptomatic THA should be questioned and requires further investigation. Based on the work of this study, the current practice of routine follow-up of asymptomatic THA may be excessively costly and unnecessary, and a less resource-intensive review method may be more appropriate. [ABSTRACT FROM AUTHOR]

Background: In Australia, the most frequently used hemiarthroplasty prosthesis for the management of displaced intracapsular femoral neck fractures is the Uncemented Austin Moore (UAM). Despite concerns regarding poor functional outcomes and increased early revision rates associated with the UAM prosthesis, apprehension regarding the systemic side-effects of polymethylmethacrylate cement implantation in the elderly patient continues to influence prosthesis selection. This study examines the incidence of early prosthesis related complications after UAM and Cemented Thompson (CT) hemiarthroplasty procedures for the management of femoral neck fractures. Methods: A multicentre retrospective review of charts and radiographs was conducted in 1118 unipolar hemiarthroplasty implantations to determine early complications associated with the CT and UAM prostheses over a 6-year period in five Queensland public hospitals. Results: Intraoperative periprosthetic fractures were sustained in 11.8% of UAM and 1.8% of CT implantations ( P < 0.0001). Intraoperative periprosthetic fractures were associated with an increased requirement for reoperation within 1 month of the index procedure ( P = 0.05). No statistical difference in the incidence of intraoperative periprosthetic fractures could be observed between the hospitals participating, regardless of the proportional use of each prosthesis. Early dislocation rates were similar for the UAM and CT prostheses. The intraoperative mortality rate attributable to the use of polymethylmethacrylate cement during hip hemiarthroplasty was 1/738 (0.14%). Conclusions: The results of this study support the use of the CT prosthesis for the management of femoral neck fractures to reduce the high incidence of intraoperative periprosthetic fractures and associated requirements for early reoperation experienced with the UAM. [ABSTRACT FROM AUTHOR]

Background: Internal fixation of fractures using plates and screws is a common method of treatment. Occasionally the internal fixation fails prior to fracture healing. This often requires revision surgery. Determining the force that internal fixation needs to withstand postoperatively would enable this force to be applied intraoperatively as a test to predict successful fixation. The purpose of the present paper was to determine the minimum stripping torque needed to predict successful internal fixation strength. Methods: The pull-out strength and stripping torque relationships of 4.5-mm cortical bone screws in Sawbones polyurethane foam were determined. Screw forces were directly measured using an LCM load cell washer on a model intertrochanteric neck of femur fracture fixed with 135° 4-hole pin and plate loaded to single leg stance conditions. Additionally a 135° 4-hole pin and plate was mounted on foam blocks and loaded until failure of the shaft screws from the foam occurred. Predicted stripping torque/yield load was determined. Results: Pull-out strength and stripping torque of 4.5-mm cortical bone screws in polyurethane foam have a high degree of linear correlation R2 = 0.95. Direct measurement of shaft screw forces at single leg stance conditions were 585−686 N. This correlated with a stripping torque of 0.9 Nm. Load to yield testing at single leg stance conditions corresponded to a stripping torque of 1.8 Nm. Conclusion: Withstanding 0.9−1.8 Nm of torque during insertion of the femoral shaft screws of a 135° 4-hole pin and plate predicts that the construct will successfully withstand single leg stance. [ABSTRACT FROM AUTHOR]