The edition · Orthopaedics
Psychiatric comorbidity was linked to more failures ten years after hip arthroscopy for impingement
Also: hip and knee replacement under 25, biportal endoscopic spine surgery and wound dehiscence, graft choice in combined ACL and MCL injuries, and the timing of a nerve block in hip fracture.
The edition in brief
A retrospective cohort of 243 adults followed for at least ten years after hip arthroscopy for femoroacetabular impingement found failure (revision arthroscopy or conversion to hip replacement) in 23.3% of those with a psychiatric diagnosis against 5.3% of those without, with anxiety and depression independently associated with failure. A meta-analysis of 44 studies (3,317 patients) found that hip and knee replacement under age 25 improved function and quality of life, with revision rates of 8.7% for hip and 12.4% for knee, higher than in older adults. A post hoc analysis of two randomised trials in 211 patients found no wound dehiscence after biportal endoscopic lumbar decompression against 8.7% after microscopic surgery, hypothesis-generating only. A prospective registry of 489 patients found nonhamstring ACL grafts associated with higher knee scores without evidence that MCL status changed the effect. A trial of 79 hip fracture patients found no significant difference in delirium (8.1% vs 12.8%) between giving a nerve block a day before surgery or an hour before. The pearl restates early surgery and delirium screening after hip fracture.
Hip and knee replacement under age 25 improves function, with higher revision rates than in older adults
Consider arthroplasty for young patients with end-stage disease after alternatives, and counsel openly about revision.
Biportal endoscopic lumbar surgery: no wound dehiscence in a pooled post hoc analysis
Worth knowing for wound surveillance after microscopic lumbar surgery; do not choose technique on this post hoc result alone.
Nonhamstring ACL grafts were linked to better scores, with no sign that MCL status changed the effect
Consider graft choice on its own merits; this registry found no clear evidence that MCL status should change it.
Nerve block a day before hip fracture surgery did not reduce delirium compared with an hour before
Worth noting but not actionable: earlier block timing did not clearly reduce delirium in a small trial.
After hip fracture, get the patient to theatre promptly and look for delirium
Prompt surgery and daily delirium screening are the basics of hip fracture care.
Psychiatric comorbidity was linked to higher failure ten years after hip arthroscopy
Consider asking about mental health before hip arthroscopy and counsel those with anxiety or depression about a higher chance of failure.
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