DOC-20250623-hiparthropsty forbjune.pptx

arthroplasty for Ortho

1. J O U R N A L A R T ICLE R E V I E W D R O N Y E J I O B I / D R N Z E ' S U N I T ( O R T H O PEDIC U N I T 3 ) P r e s e n t e r : D r N w a o gwugwu . 2 3 r d / 6 / 2 2 5

2. T I T L E O N E - S T A G E D C O M B I N E D H I P A N D K N E E A R T H R O PLASTY : R E T R OSPECT I V E COMPARATIVE S T U D Y A T M I D T E R M F O L L O W UP

3. A u t h o r s S t e f a n o p e t r i l l o M a t t e o m a r u l l o M i c h e l e c o r b e l l a Paolo p e r a z z o S e r g i o R o m a g n o l i

4. P u b l i c a t i o n R E C E I V E D : 8 t h / June / 2 1 9 D A T E A C C E P T E D : 1 9 / a u g u s t / 2 1 9 P U B L I S H E D O N L I N E : 5 / September 2 1 9 P U B L I S H E D I N : J O U RNAL O F O R T H OPEDIC S U R GERY A N D R E S E A R C H

5. S T UDY L O C A T ION P r o s t h e t ic surgery c e n t er , I R C C S O r t h o p a e d i c i n s t i t u t e G a l e a z z i . M i l a n Italy

6. B a c k g r o u n d l i t e r ature A R T H R O P L ASTY A R T H R O P L A S T Y I S A N O R T H OPEDIC P R O C EDURE T O P A R T I A L L Y O R C O M P L E TELY R E S U R F A C E , R E M O D E L , R E C O N S T R U C T O R R E P L A C E A N A R T H R I T I C , DYSFUNCTION AL , O R N E C R O T IC A R T I C U L A R S U F A C E O F A J O I N T . E P I D E M I O L O G Y

7. K e y t e r m s f r o m t h e a r t i c l e H A R R I S H I P S C O R E W e s t e r n O n t a r i o a n d M c m a s t e u n i v e r s i t i es o s t e o a r t h ritis s c o r e f o r t h e k n e e ( K - W O M A C ) And F O R T H E H I P ( H - W O M A C ) : It's a q u e s t i o n n a ire u s e d t o a s s e s n p a i n a n d stiffness a n d p h y s i c a l f u n ction i n i n d i v idual s w i t h o s t e oarthritis . K N E E S O C I E T Y S C O R E . It's a s y s t e m u s e d t e v a l u a t e t h e knee a n d p a t ients functional a b i l i ties b e f o r e a n d a f t e r t o t a l k n e e ARTHROPLASTY . I t h a s t w o m a i n c o m p o nents a function s c o r e w h i c h e v a l u a t e s w a l k i n g d i s t a n c e a n d s t a i r c l i m b i n g a b i l i t y a n d a k n e e s c o r e which a s s e s s brain , r o m , s t a b i l ity a l i g n m ent

8. J O U R NAL R E V I E W .

9. O U T L I N E I n t r o d u c tion A i m o f study M a t e r i a l s a n d methods R e s u l t s D i s c u s s i on C o n c l u s i on C r i t i q ue

10. INTRODUCTION Hip and knee osteoarthritis (OA) are among the most disabling musculoskeletal disorders, affecting 4.2% and 10.1% of adults over 60 years, respectively. For patients with coexisting severe hip and knee OA, surgical management typically involves staged arthroplasties. While one-staged bilateral hip or knee procedures have been studied, combined one-staged hip and knee arthroplasty remains rare (<0.5% of cases) and under-investigated. Prior literature reports complication rates of 16.7–19.5% and variable implant survivorship (94% at 3 years; 83% at 5 years) for one-staged approaches, highlighting significant knowledge gaps regarding safety and efficacy.

11. AIM OF STUDY To compare complications, functional outcomes, and implant survivorship between one-staged and two-staged combined hip and knee arthroplasty in patients with coexisting severe OA.

12. MATERIALS AND METHODS Study Design: Retrospective matched-pair study (Level III evidence). Participants inclusion criteria: - 42 patients with KL grade ≥3 hip/knee OA and impaired walking capacity (<100m autonomy) - Group A (One-staged): 21 patients (69±7.9 years; 52% male) - Group B (Two-staged): 21 patients (70.1±10.2 years; 43% male) Interventions: - Hip: Minimally invasive posterior approach; uncemented cups and cementless stems - -Knee: 71.4% "small implants" (UKA/PFJ); 28.6% TKA; Anesthesia: Combined spinal-epidural; tranexamic acid (1g IV preoperatively + 5h postoperatively)

13. METHOD AND MATERIALS Outcome Measures: - 1. Complications (surgical site infection, revisions) 2. Functional scores (HHS, KSS, WOMAC) 3. Hemoglobin level and transfusion rates 4. Hospital stay duration 5. I mplant survivorship (radiographic assessment) Statistical Analysis: Mann-Whitney U (continuous variables); χ² (categorical); Kaplan-Meier (survivorship);

14. RESULT Follow Up average :- 42 . 8 months in grouration and 53.6 months in group B . With no statistical signicant difference in demographics Blood loss and transfusion: statistical signicant difference with group A having a greater drop in hb value and having more transfusion at 14.3 % vs 9.5% of group B Surgery duration and hospital stay: group A had a shorter hospital stay averaging 15.5 vs 27.5 of B and a shorter surgery duration of 62 +- 14.2 mins vs 66+- 15.3 mins Clinical and fucntional outcomes – No statistical difference was found

15. Discussion One-staged combined hip and knee arthroplasty is a feasible option for severe osteoarthritis, offering complication rates comparable to staged procedures while significantly reducing hospitalization time. Key factors enabling success include: 1. Use of “small implants” (UKA/PFJ) in 71.4% of knees, minimizing surgical impact. 2. Effective hemoglobin management with tranexamic acid despite greater blood loss.

16. DISCUSSION while its Limitations of (retrospective design, small sample, implant heterogeneity) require cautious interpretation, but the approach shows promise for selected patients in specialized centers, potentially reducing costs and streamlining recovery. Prospective trials with larger cohorts and longer follow-up are needed for validation.

17. conclusion One-staged combined hip and knee arthroplasty is a safe, effective option for coexisting severe OA, providing:
1. Equivalent complications and functional outcomes to staged procedures
2. Significantly reduced hospitalization
3. 100% implant survivorship at mid-term follow-up
It should be considered for selected patients, though larger randomized trials are needed for validation.

18. C r i t i q u e M E R I T 1 matched pair d e s i g n - c o n t r o l l e d f o r a g e , B M I a n d f o l l o w u p e n h a n c i n g c o m p a r a b i lity 2 s u r gery w a s p e r f o rmed b y o n e p e r s o n , a s i n g l e h i g h v o l u m e s u r g e o n u s i n g m o d e r n t e c hniques . 3 c o m p r ehen sive assessment f o r o u t c o m e m e a s u r e s 4 C l i n i c a l r e l e v a n c e : demonstrated 4 3 % s h o r t e r h o s p i t a l s t a y s w i th o u t c o m p l i cations .

19. C r i t i que M E R I T . 5 c o m p e t i n g i n t e r e s t : n o n 6 a i m s c l e a r l y s t a t e d

20. Critique DEMERIT 1 SMALL SAMPLE SIZE 2 SELECTION BIAS : NON RANDOMIZED ALLOCATION 3 DIFFERENT knee IMPLANTS MAY AFFECT HOW PROCEDURE WAS DONE OBSCURING PROCEDURE SPECIFIC OUTCOME 4 SHORT FILLOW UP OF 50MONTHS MAKES ITS DOFFICULT TO EVEALUTE IMPLANT SURVIVORSHIP 5 IMCOMP

21. sir we had a trauma case from the A and E chineme ,uzuchukwu 53265 A 22 Y/O MALE FROM IHEMBOSI , ANAMBRA , PRESENTED WITH A; 1,RIGHT LOWER LEG WOUND 2 RIGHT LOWER LEG PAIN 3 INABILITY OF BEAR WEIGHT ON THE RIGHT LOWER LIMB. ALL OF 1 HOUR DURATION PTP HE WAS INVOLVED IN A HEAD-TO SIDE MCRTA WITH ANOTHER -COMING MOTOCYCLE WHEN HE SUSTAINED THE ABOVE INJURIES , NO LOC, SEIZURES OR BLEEDING FROM CRANIO FACIAL ORIFICES HOWEVER THERE WAS ASSOCIATED BLEEDING FROM THE RIGHT LEG NO CHEST PAIN , COUGH, SOB OR ABNORMAL CHEST WALL MOVT. NO URINARY RETENTION, BLOOD AT THE TIP OF THE PENIS/ HEMATURIA. NO ABDOMINAL PAIN , SWELLING OR DISTENTION. NO VOMITING , HEMATEMESIS OR HEMATOCHEZIA. NO OTHER HX SUGGESTING INJURY TO OTHER AREAS OF THE BODY NOT A KNOWN HTN/DM/SCD/ ASTHMATIC/PUD PATIENT. NIL HX OF BLOOD TRNASFUSION OR SURGERY NO KNOWN DRUG ALLERGIES. O/E= IN PAINFUL DISTRESS, AFEBRILE, NOT PALE, ANICTERIC, ACYANOSED, NOT DEHYDRATED. V/S= PR= 96BPM RR,- 24 CPM . BP= 150/80 MMHG, SPO2 =98%. IN ROOM AIR GCS = 15/15 HB - 14.9 G/DL ABD _ NAD HEENT - NAD MSS RIGHT LOWER LIMB : 6X 7 CM WOUND AT THE ANTERIOR- MEDIAL -HALF OF THE LOWER LEG WITH THE TIBIAL BONE VISIBLE , A 10X 8CM POSTERO- MEDIAL MORE PROXIMAL LACERATION WITH AN OUT-BULGING OF THE GASTRONECMIUS , MULTIPLE SMALL ABRASIONS ON THE LOWER LEG. ABNORMAL MOBILITY OF THE LEG , TIBIALIS POSTERIOR NOT FELT , DORSAL PEDIS PULSE NOT FELT , POPLITEAL PULSE WAS FELT , LACHMANNS TEST NEGATIVE , VARUS AND VALGUS STRESS TEST NEGATIVE X RAY SHOWED A RIGHT OBLIQUE TIBIAL FRCATURE AT THE MID -SHAFT AND A PROXIMAL ⅓ COMMNUITED FRACTURE OF THE RIGHT FIBULAR ASS : RIGHT OPEN DISPLACED MIDSHAFT TIBIAL FRACTURE (GA - TYPE IIIA) (AO 42-A) AND COMUNITED PROXIMAL FIBULAR FRACTURE PLAN URGENT PCV , FBC, SEUCR , RVS, HBSAG, HCV , SEUCR CHEST X RAY, RIGHT LEG XRAY AP/LATERAL IV NORMAL SALINE 1 LITRE 12HRLY IM PENTAZOCINE 30MG 8HRLY IM PARACETAMOL 8 HRLY MESPORIN 1 GRAM DLY LEVOFLOXACIN 500MG DLY TINIDAZOLE 800MG DLY IM TT 0.5 MLS STAT SC ATS 1500 IU AFTER A NEGATIVE TEST DOSE DAILY WOUND DRESSING WITH NORMAL SALINE APPLY ABOVE KNEE BACK SLAB MONITOR VITALS TABS DABIGATRAN 220MG DLY TABS FESOLATE 200MG DLY TABS VIT C 200M TDS TABS VIT E 1000 IU DLY TABS VIT A 10000 IU DLY TABS SELENIUM 200MCG DLY TABS ZINC 50MG DLY INFORM SENIORS