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Background: The rate of major surgical complications for high-volume orthopedic surgeons using the direct anterior approach (DAA) in Ontario, Canada, is not known. The purpose of this study was to investigate the rate of major surgical complications after total hip arthroplasty (THA) using DAA performed by experienced orthopedic surgeons at a high-volume tertiary care centre in Ontario. Methods: We conducted a retrospective cohort review of primary THA through DAA performed by 2 experienced fellowship-trained surgeons at an academic hospital in London, Ontario, between Jan. 1, 2012, and May 1, 2019. We excluded the first 100 cases to allow for surgeon learning curves. We recorded major surgical complications (intraoperative events, postoperative periprosthetic fractures, dislocation requiring closed or open reduction, implant failure [aseptic loosening or subsidence], early (< 6 wk) deep wound infection requiring irrigation and debridement, late ([greater than or equal to] 6 wk) deep wound infection requiring irrigation and debridement, and wound complications [wound dehiscence, stitch abscess, erythema, hematoma or seroma]) within 1 year of THA. Results: A total of 875 primary DAA THA procedures were included. The rates of surgical complications were 0.9% for intraoperative events, 1.5% for postoperative periprosthetic fractures, 0.8% for implant failure, 0.7% for early deep wound infection, 0.1% for late deep wound infection and 3.2% for wound complications; there were no cases of dislocation. The rate of revision for implant failure within 1 year was 0.1%. Male sex was associated with a greater risk of implant failure (p = 0.01), and having a higher body mass index was associated with both increased rates of infection (p < 0.01) and having a wound complication (p < 0.01). Conclusion: Intraoperative events, postoperative periprosthetic fractures, implant failure, deep wound infection and wound complications accounted for the major surgical complications within 1 year of THA through DAA. The low revision rate suggests that DAA is a safe approach for THA. Contexte: On ignore quel est le taux de complications majeures des chirurgies pour prothèse totale de la hanche (PTH) par abord antérieur direct (AAD) d'une équipe de chirurgie orthopédique de fort volume en Ontario, au Canada. Cette étude avait pour but d'analyser le taux de complications chirurgicales majeures suite à des PTH par AAD effectuées par une équipe d'orthopédistes chevronnés dans un centre de soins tertiaires achalandé de l'Ontario. Méthodes: Nous avons procédé à une analyse de cohorte rétrospective des PTH primaires par AAD effectuées par 2 spécialistes expérimentés dans un hôpital universitaire de London, en Ontario, entre le 1er janvier 2012 et le 1er mai 2019. Nous avons exclu les 100 premiers cas pour permettre l'établissement des courbes d'apprentissage en chirurgie. Nous avons consigné les complications chirurgicales majeures (événements peropératoires, fractures périprothétiques postopératoires, dislocation nécessitant une réduction fermée ou ouverte, défaillance de la prothèse [descellement aseptique ou enfoncement], infection profonde rapide (< 6 semaines) de la plaie nécessitant un traitement par irrigation et débridement, infection profonde tardive ([supérieur ou égal à ] 6 semaines) de la plaie nécessitant un traitement par irrigation et débridement, et complications de plaies [déhiscence, abcès aux points de suture, érythème, hématome ou sérome]) au cours de l'année suivant la PTH. Résultats : En tout, 875 interventions primaires pour PTH par AAD ont été incluses. Les taux de complications chirurgicales ont été de 0,9% pour les événements peropératoires, de 1,5% pour les fractures périprothétiques postopératoires, de 0,8% pour la défaillance de la prothèse, de 0,7% pour l'infection de plaie profonde rapide, de 0,1% pour l'infection de plaie profonde tardive et de 3,2% pour les complications de plaies; on n'a noté aucun cas de dislocation. Le taux de révision pour défaillance de la prothèse dans l'année suivant l'intervention a été de 0,1%. Le fait d'être de sexe masculin a été associé à un risque plus élevé de défaillance de la prothèse (p = 0,01) et le fait d'avoir un indice de masse corporelle plus haut a été associé à des taux plus élevés d'infection (p < 0,01) et de complications de plaies (p < 0,01). Conclusion : Les événements peropératoires, les fractures périprothétiques postopératoires, la défaillance de la prothèse, l'infection de plaie profonde et les complications de plaies ont été les complications chirurgicales majeures enregistrées durant la période d'un an suivant les interventions pour PTH par AAD. Le taux faible de révision permet de supposer que l'AAD est une approche sécuritaire pour la PTH., Total hip arthroplasty (THA) is an appropriate treatment option for severe hip osteoarthritis. It is one of the most reliable and reproducible procedures in orthopedic surgery, achieving a success rate [...]

Purpose: To determine the associations between glycated hemoglobin (A1C) values at three, 12 and 24 months postpartum taken during the Families Defeating Diabetes trial.Methods: The Families Defeating Diabetes trial was a randomized 12 month lifestyle intervention delivered in the first year postpartum. Women were reviewed at three, 6 12 and 24 months for body habitus, diet and lifestyle choices. Glycated hemoglobin levels were measured at three, 12 and 24 months.Results: There were 170 randomization participants: 89 interventional (INT); and 81 control (CON). Of these 170 participants, 50 INT and 47 CON completed 12-month follow-up and 26 INT and 24 CON completed 24-month follow-up. Study outcomes did not differ between the cohorts. Combined intraclass correlation coefficients for reliability of repeated results showed substantial reliability: 0.74 (95% CI 0.63, 0.83) between three and 12 month A1C; and 0.72 (95% CI 0.51, 0.85) for three and 24 month A1C. Pearson correlations for three month vs 12 month A1C were r=0.745 (p. [ABSTRACT FROM AUTHOR]

Objective: To determine the effect of deltoid ligament repair on the development of posttraumatic arthritis in logsplitter ankle injuries., Methods: Design: Retrospective cohort., Setting: Academic, Level I trauma center., Patient Selection Criteria: Patients ≥18 years of age with logsplitter injuries (OTA/AO 44B, 44C) treated with open reduction internal fixation with or without deltoid ligament repair from January 2008 to October 2021., Outcome Measures and Comparison: The rate of posttraumatic arthritis (PTOA) development at final follow-up (minimum 6 months) after open reduction internal fixation was evaluated using the Kellgren-Lawrence scale. The achievement of acceptable reduction indicated by articular reduction <2mm, and a medial clear space ≤4mm was assessed at 6 weeks postoperatively with weightbearing radiographs. The effect of deltoid ligament repair on the development of PTOA was investigated., Results: Fifty-nine patients aged 49.1 ± 17.2 years met inclusion criteria with a mean follow up of 16.6 months (range = 6 to 96). Twenty-six of 59 patients (44%) had developed PTOA at final follow-up. Acceptable reduction was achieved in 83.1% (49/59) of fractures. The acceptable reduction rate in fractures undergoing deltoid ligament repair was 100% versus 78% in those without deltoid ligament repair (13/13 vs. 36/46, p=0.017). The rate of PTOA development was significantly lower in patients who underwent deltoid ligament repair (15%) compared to those who did not (52%), p=0.026. Patients who underwent deltoid ligament repair had a significantly reduced rate of PTOA development leading to arthrodesis compared to those who did not (0% vs. 17%, p=0.013)., Conclusions: Logsplitter injuries resulted in a high rate of development of posttraumatic arthritis. An acceptable reduction is required to minimize risk of development of PTOA and progression to arthrodesis. Deltoid ligament repair during open reduction internal fixation may facilitate acceptable reduction, decrease the rate of PTOA and progression to arthrodesis in these injuries., Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence., Competing Interests: Potential Conflicts of Interest and Funding Sources: None, (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

The primary objective of this review was to determine whether the attenuation of the postoperative inflammatory response (PIR) after total knee arthroplasty (TKA) leads to a notable improvement in clinical outcome scores. The secondary objective of this review was to determine the optimal approach in using inflammatory biomarkers, clinical inflammatory assessments, and imaging to quantify the PIR. A systematic literature search of eight major databases was conducted using a predetermined search strategy. C-reactive protein (CRP), interleukin-6 (IL-6), erythrocyte sedimentation rate (ESR), knee surface temperature (KST), and clinical outcome data were collected and graphically displayed. Eighty-six percent of the studies that reported a statistically significant decrease in inflammatory biomarkers in their treatment group demonstrated a concordant notable improvement in clinical outcome scores. Mean CRP, IL-6, ESR, and KST values peaked on postoperative day (POD) 2, POD1, POD7, and POD 1-3, respectively. The PIR is correlated with early pain and function recovery outcomes. Future studies comparing TKA surgical methodologies and perioperative protocols should assess PIR by incorporating inflammatory biomarkers, such as CRP and IL-6, and clinical inflammatory assessment adjuncts, to provide a more comprehensive comparison., (Copyright © 2024 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Orthopaedic Surgeons.)