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Background The post-colonoscopy periprosthetic joint infection (PJI) risk in patients with total prosthetic knee joints has limited research. The present study investigated the PJI risk and determined the risk factors for post-colonoscopy PJI in total knee arthroplasty (TKA) recipients. The hypothesis was that colonoscopy is associated with an increased PJI risk in patients with total prosthetic knee joints. This study can potentially help guide the decision making for prophylactic antibiotic use for colonoscopy. Methods This nationwide matched cohort study used claims data from the Health Insurance Review and Assessment Service database and enrolled patients who underwent unilateral TKA between 2008 and 2016. The history of diagnostic colonoscopy was investigated at least 1 year postoperatively. The propensity score was matched between colonoscopy and non-colonoscopy cohorts, and the post-colonoscopy PJI risk was compared. The PJI risk following invasive colonoscopic procedures, including biopsy, polypectomy, and mucosal or submucosal resection, was investigated, and the risk factors for post-colonoscopy PJI were determined. Results In total, 45,612 and 211,841 patients were matched in the colonoscopy and control cohorts, respectively. The colonoscopy cohort had greater 9-month and 1-year PJI risks from the index colonoscopy date than the matched controls (9 months: hazard ratio [HR] 1.836, P = .006; 1 year: HR 1.822, P = .031). Invasive colonoscopic procedures did not increase the PJI risk at any time point post-colonoscopy. The only significant risk factor for PJI was post-traumatic arthritis (adjusted HR 4.034, P = .023). Conclusion Colonoscopy was associated with an increased PJI risk in TKA recipients, regardless of concomitant invasive colonoscopic procedures. Level of evidence III, Prognostic.

This study aimed to compare the reliability of two gap assessment methods (component and bone surface gap measurement vs. planned gap balance) and identify the contributors to component gaps other than planned gaps. The prospectively collected data for 122 consecutive primary total knee arthroplasties (TKAs; 114 patients). After femoral planning for gap balancing, the medial and lateral planned gaps were calculated (planned gap). The established medial extension and flexion gaps (MEG and MFG, respectively) and lateral extension and flexion gaps (LEG and LFG, respectively) were measured with and without the TKA components (bone surface and component gaps) at 0° and 90° flexion. The intraclass and Pearson correlation coefficients for each gap measurement method were assessed using planned gap values, and multiple linear regression analyses were performed to identify the contributors to component gaps. Compared with the bone surface gap measurement, the component gap measurement showed higher reliability and stronger correlation with the planned gap balance for each gap. The changes in the medial posterior femoral offset contributed to the MEG and LEG, whereas those in the joint line height contributed to the LEG. The changes in the hip–knee–ankle angle and lateral posterior femoral offset contributed to the LFG. Component gap measurements of the established gap more accurately and reliably reflect the planned gap balance than do bone surface gap measurements. The established gaps are affected by several factors other than femoral planning.

Purpose Postoperative pneumonia is a common and devastating complication of hip fracture surgery in older individuals. This study aimed to determine the relationship between early postoperative hypoalbuminaemia and pneumonia after hip fracture surgery. Patients and Methods In this retrospective cohort study conducted at one centre, we reviewed the medical records of 1155 consecutive patients (>60 years) who underwent hip fracture surgery. Multivariate logistic regression analysis was performed to identify the independent risk factors for postoperative pneumonia. After determining the cut-off value for postoperative serum albumin, the patients were divided into two groups according to the minimum serum albumin level recorded during the first two postoperative days: group A included patients with a minimum serum album level less than 3.0 g/dL and group B included patients with a minimum serum album level of at least 3.0 g/dL. The prevalence of postoperative pneumonia was analysed using inverse probability of treatment weighting (IPTW) and propensity score matching (PSM) analyses. Results The incidence of postoperative pneumonia following hip fracture surgery was 5.1% (n=59). Age, cardiovascular disease, and early postoperative hypoalbuminaemia during the first two postoperative days were independent risk factors for postoperative pneumonia. Early postoperative hypoalbuminaemia was associated with postoperative pneumonia development in the PSM and IPTW analyses (P = 0.016 and

Introduction Posterior wall fractures may be associated with both-column acetabular fractures. Considering the differences in the pattern of these fractures in contrast to isolated posterior wall fractures, it is currently unclear whether they can be ignored or need to be addressed surgically. Hypothesis Stable posterior wall fractures can be skilfully ignored in patients with both-column acetabular fractures operated by an ilioinguinal approach. Material and methods We retrospectively reviewed 49 consecutive patients who were treated for both-column acetabular fractures between the years 2009 and 2018. Considering the association of posterior wall fractures, we divided the cohort into two groups: Group 1 (n = 29): absence of posterior wall fractures; and Group 2 (n = 20): presence of posterior wall fractures, subsequently treated while skilfully ignoring stable posterior wall fracture according to our criteria. Intergroup comparison of radiologic and clinical outcomes and multiple linear regression for predictors of clinical outcomes were analysed. Results No significant intergroup difference in quality of reduction, post-traumatic osteoarthritis grade, or clinical outcome was noted. Poor post-traumatic osteoarthritis grade and poor quality of reduction of both acetabular columns were significant predictors of clinical outcomes in patients with both-column acetabular fractures. Whether posterior wall fracture was associated and skilfully ignored was unrelated to clinical outcomes. Discussion Posterior wall fractures associated with both-column acetabular fractures can be successfully ignored if the posterior wall fragment is adequately attached to the acetabulum through the labrocapsular complex of the hip joint, and the hip-joint-congruency in the presence of Level of proof III, prognostic.

The objectives were to compare the coronal joint configuration of the knee joints, coronal gap imbalances requiring substantial medial release, and patient-reported outcomes, including the forgotten joint score, between knees in which residual varus alignment was intentionally allowed according to an individualised lower limb analysis and those with mechanical alignment in total knee arthroplasty for varus osteoarthritis. Consecutive primary navigated total knee arthroplasty procedures for varus osteoarthritis were retrospectively reviewed. The study cohort was stratified based on whether residual varus alignment was intentionally allowed. Propensity-score matching was performed based on the baseline characteristics, including demographic characteristics, preoperative radiological measurements, and the Western Ontario and McMaster University Osteoarthritis Index (mechanical alignment group vs residual varus group). The patient-reported outcomes and coronal joint line orientation of the knee (relative to the ground) and ankle were evaluated. Coronal gap differences and coronal gap imbalances were analysed using intraoperative gap measurements. Relative to the ground and ankle, the postoperative knee joint line orientation slanted down laterally in the mechanical alignment group (− 3.05˚ ± 1.62, relative to the ground; − 2.65˚ ± 1.56, relative to the ankle joint), but was parallel in the residual varus group (− 0.75˚ ± 1.59, relative to the ground; − 0.95˚ ± 1.71, relative to the ankle joint). Coronal gap differences at extension and the proportion of coronal gap imbalances requiring substantial medial release were 1.27 ± 1.53 and 6% in the residual varus group and 2.32 ± 1.24 and 15% in the mechanical alignment group. Postoperatively, the residual varus group showed higher Western Ontario and McMaster University Osteoarthritis Index scores and total forgotten joint scores than the mechanical alignment group (6.97 ± 4.75 vs. 10.31 ± 5.74 and 56.42 ± 12.85 vs. 45.69 ± 14.49, respectively). Intentionally allowed residual varus alignment with individualised analysis of lower limb alignment restored the parallel joint line of the knees, preserved the soft tissue envelope, and reduced joint awareness after total knee arthroplasty for varus osteoarthritis. Therapeutic, Level III retrospective case–control study

Purpose To verify the accuracy of supine nonweight-bearing radiography versus standing radiography in preoperative planning and to determine the predictors of unintended limb alignment correction in medial open-wedge high tibial osteotomy (OWHTO). Methods Consecutive patients who underwent medial OWHTO for medial osteoarthritis of the knee with varus alignment were retrospectively reviewed. The analyzed pre- and postoperative radiologic measurements included postoperative mechanical axis deviation (MAD) on standing whole-leg radiographs (WLRs), the predicted value of the postoperative MAD on the preoperative supine (predicted MADsupine) radiograph, and standing WLRs (predicted MADstand). Multiple linear regression analysis was used to identify variables predicting the postoperative MAD and unintended MADstand correction, defined as the difference between predicted MADstand and postoperative MAD. Results Predicted MADsupine showed statistically greater reliability in predicting postoperative MAD than predicted MADstand (intraclass correlation coefficient, 0.82 vs 0.45). Postoperative MAD was correlated with the predicted MADsupine and the difference in hip–knee–ankle angle between preoperative standing and supine WLRs (ΔHKA anglestand-supine) (R =763, R2 = 0.582, adjusted R2 = 0.569, P Conclusions Preoperative planning with supine WLRs can predict postoperative limb alignment in medial OWHTO more accurately than standing radiographs. The clinical significance of the ΔHKA anglestand-supine for the risk of overestimation of postoperative limb alignment might be low because of the low power in the prediction model and small value of the ΔHKA anglestand-supine. Preoperative soft-tissue laxity was significantly correlated with unintended correction of postoperative limb alignment resulting from preoperative planning with standing radiographs. Level of evidence Level IV, retrospective comparative study

Background Unnecessary costs and complications can be reduced by increasing hemoglobin (Hb) levels and minimizing blood transfusions in patients who underwent total knee arthroplasty (TKA). This study aimed to determine the effects of intravenous iron monotherapy before TKA on preoperative iron deficient anemia and postoperative transfusion rates. Methods This prospective cohort study included 45 patients scheduled for TKA in the experimental group (Group I) and 221 patients who underwent TKA in 2015 and 2018 in the control group (Group C). One thousand milligrams of ferric carboxymaltose was administrated 1 month before TKA in group I. Intergroup comparison of the rate and total volume of transfusion, perioperative changes in Hb and analysis of iron metabolism variables in group I were performed. Subgroup analysis of Group I was conducted according to the response to iron monotherapy. Results Although Hb levels increased after intravenous iron monotherapy in Group I, postoperative transfusion rates in Groups I and C were 17.8% and 18.6%, respectively, without significant intergroup differences in the rate and total units of transfusion. Ferritin level and transferrin saturation were corrected in both subgroups of Group I. Only 17 patients (37.78%) showed response to iron monotherapy, with an Hb increase of 1.0 g/dL or more. Subgroup analysis showed lower proportions of coexisting chronic diseases, including chronic kidney disease in responders. Conclusion IV iron monotherapy was shown to be insufficient in successfully treating preoperative iron-deficient anemia to reduce postoperative allogenic blood transfusion in patients who underwent TKA. As preoperative anemia should be managed due to the high rates of postoperative transfusion for this surgery, clinicians should consider the complex interplay among the causal factors of anemia, apart from ID, in patients with preoperative anemia who are scheduled for TKA.

Background Unnecessary costs and complications can be reduced by minimizing blood loss and allogeneic blood transfusion in cases of total knee arthroplasty (TKA). This study evaluated the effectiveness of bone wax in reducing blood loss and transfusion rates after TKA. Methods A total of 674 consecutive TKAs performed for degenerative osteoarthritis were retrospectively reviewed. Propensity score-matching and inverse probability of treatment weighting analyses were performed for demographics, comorbidities, use of medications, preoperative laboratory findings and radiologic prosthetic coverage of osteotomy surface. In the bone wax group, bone wax (2.5 g) was applied to the uncovered bone section around the prostheses along with the topical administration of tranexamic acid, whereas hemostasis was achieved in the control group with the topical administration of tranexamic acid. Intergroup comparisons of estimated blood loss, decreases in hemoglobin (Hb) levels, and transfusion rates were performed. Results The mean estimated blood loss and volume of postoperative drainage were reduced in the bone wax group. The maximum decreases in Hb levels on postoperative days 1, 3, 5, and 7 were 1.8 ± 0.7 ml, 2.5 ± 0.8 ml, 2.7 ± 0.8 ml, and 2.8 ± 0.8 ml in the bone wax group and 2.1 ± 1.0 ml, 3.0 ± 1.2 ml, 3.1 ± 1.1 ml, and 3.2 ± 1.1 ml in the control group, respectively. The postoperative transfusion rates decreased markedly from 8.8% to 2.0% when bone wax was used. Conclusions The use of bone wax significantly reduced blood loss, decreased Hb levels, and the risk of transfusion. Level of evidence: Level III, Therapeutic studies.

Osteosynthesis is recommended for Garden I and II femoral neck fracture treatment using parallel partially threaded cannulated screws. Postoperatively, excessive femoral neck shortening (FNS) and posterior tilt of the femoral neck (PTFN) are frequently encountered and are correlated with impaired quality of life and clinical outcomes. We hypothesized that stabilization by parallel partially threaded cannulated screws replacing a posterior partially threaded screw with a fully threaded positioning screw would improve fracture healing without further FNS and PTFN in femoral neck fractures.We retrospectively reviewed Garden I and II femoral neck fractures treated by in situ fixation using parallel cannulated screws at our institution between January 2010 and November 2018. Patients with the applicable fractures were divided according to the utilization of posterior fully threaded screws: patients with partially threaded screws were included in Group C and those with posterior fully threaded screws were included in Group P. Intergroup comparisons were performed based on radiographic measurements that assessed the shortening in two vectors (the horizontal and vertical axes), FNS, and subsequent PTFN.No significant intergroup difference was found in demographics and fracture characteristics, except in the follow-up duration. The mean FNS and shortening in both vectors were significantly smaller in Group P than in Group C (FNS, 5.02 ± 1.31 vs. 8.84 ± 3.48 mm, p0.001; horizontal axis, 4.07 ± 1.06 vs. 6.18 ± 2.77 mm, p0.001; and vertical axis, 2.55 ± 1.68 vs. 5.74 ± 3.41 mm, p 0.001). The mean subsequent PTFN was significantly smaller in Group P (2.21 ± 2.99 vs. 7.56 ± 6.20 mm, p 0.001). A significantly smaller number of patients in Group P had moderate (5-10 mm) or severe (10 mm) FNS and moderate (5-10°) or severe (10°) subsequent PTFN.Parallel cannulated screws replacing a posterior partially threaded screw with a fully threaded positioning screw as a length- and angle-stable construct for Garden I or II femoral neck fracture fixation can prevent femoral neck collapse in both the coronal and axial planes.

Acute kidney injury (AKI) is a common and serious complication after hip fracture surgery in older adults. Hypoalbuminemia is a known independent risk factor for AKI. However, few studies have investigated the relationship between early postoperative hypoalbuminemia and AKI after hip fracture surgery. Therefore, we sought to determine the incidence of and risk factors for AKI and the effects of early postoperative hypoalbuminemia on AKI incidence after surgery for hip fractures, especially intertrochanteric fractures of the proximal femur.In this retrospective cohort study from a single center, we reviewed the medical records of 481 consecutive patients (60 years) who underwent surgery for intertrochanteric fracture of the proximal femur. Multiple logistic regression was performed to identify independent risk factors for AKI. After determining the cut-off value of the minimal level of postoperative serum albumin during the first two postoperative days, we divided the patients into two groups: group 1 included 251 patients whose minimal early postoperative serum albumin level was2.9 g/dL during the first two postoperative days; and group 2 included 230 patients whose minimal early postoperative serum albumin level was ≥2.9 g/dL. The incidence of AKI was analyzed using inverse probability of treatment weighting (IPTW), propensity score matching (PSM), and propensity score matching weighting (PSMW) analyses.The incidence of AKI, defined based on the Kidney Disease Improving Global Outcomes criteria, was 11.8% (n = 57). Chronic kidney disease and the minimal early postoperative serum albumin level2.9 g/dL at any point during the first two postoperative days were independent risk factors for AKI. The IPTW, PSM, and PSMW analyses comparing the incidence of AKI between the two groups revealed that the minimal early postoperative serum albumin level2.9 g/dL was significantly associated with AKI development (P 0.001, P = 0.025, and P = 0.011, respectively).The incidence of postoperative AKI was 11.8%. Our findings demonstrate that early postoperative hypoalbuminemia is an independent risk factor for AKI in patients undergoing surgery for intertrochanteric fracture of the proximal femur.

Introduction Posterior wall fractures may be associated with both-column acetabular fractures. Considering the differences in the pattern of these fractures in contrast to isolated posterior wall fractures, it is currently unclear whether they can be ignored or need to be addressed surgically. Hypothesis Stable posterior wall fractures can be skillfully ignored in patients with both-column acetabular fractures operated by an ilio-inguinal approach. Material and methods We retrospectively reviewed 49 consecutive patients who were treated for both-column acetabular fractures between the years 2009 and 2018. Considering the association of posterior wall fractures, we divided the cohort into two groups: group 1 (n = 29) absence of posterior wall fractures; and group 2 (n = 20) presence of posterior wall fractures, subsequently treated while skillfully ignoring stable posterior wall fracture according to our criteria. Intergroup comparison of radiologic and clinical outcomes and multiple linear regression for predictors of clinical outcomes were analyzed. Results No significant intergroup difference in quality of reduction, post-traumatic osteoarthritis grade, or clinical outcome was noted. Poor post-traumatic osteoarthritis grade and poor quality of reduction of both acetabular columns were significant predictors of clinical outcomes in patients with both-column acetabular fractures. Whether posterior wall fracture was associated and skillfully ignored was unrelated to clinical outcomes. Discussion Posterior wall fractures associated with both-column acetabular fractures can be successfully ignored if the posterior wall fragment is adequately attached to the acetabulum through the labrocapsular complex of the hip joint, and the hip-joint-congruency in the presence of Level of proof III, prognostic.

There are limited reports on the effect of platelet-rich plasma (PRP) on meniscus healing. The purpose of this study was to investigate the effect of leukocyte-rich PRP (L-PRP) on potential healing of the horizontal medial meniscus tears in a rabbit model. A horizontal medial meniscus tear was created in both knees of nine skeletally mature adult rabbits. Left or right knees were randomly assigned to a L-PRP group, or a control group. 0.5 mL of L-PRP from 10 mL of each rabbit’s whole blood was prepared and injected into the horizontal tears in a L-PRP group. None was applied to the horizontal tears in a control group. The histological assessment of meniscus healing was performed at two, four, and six weeks after surgery. We found that there were no significant differences of quantitative histologic scoring between two groups at 2, 4, and 6 weeks after surgery (p>0.05). This study failed to show the positive effect of single injection of L-PRP on enhancing healing of the horizontal medial meniscus tears in a rabbit model. Single injection of L-PRP into horizontal meniscus tears may not effectively enhance healing of horizontal medial meniscus tears.