The edition · Orthopaedics
Fix-and-replace for older adults with acetabular fractures, Parkinson disease before knee replacement, and a hip capsulotomy comparison
A pooled analysis favours primary arthroplasty over fixation alone in selected older patients with acetabular fractures, a Korean cohort links earlier Parkinson disease to a small rise in vascular events after knee replacement, and two capsulotomy techniques perform alike at two years.
The edition in brief
A systematic review of 20 mostly observational studies (2,703 patients, mean age 74) compared open reduction and internal fixation with primary total hip arthroplasty or combined fix-and-replace for geriatric acetabular fractures. Primary arthroplasty gave higher 3-month Harris Hip Score (73.6 vs 66.3) and fewer reoperations (pooled OR 2.34 in favour of arthroplasty), at the cost of longer operations (185 vs 125 minutes) and more blood loss; 90-day mortality did not differ significantly (OR 1.08, 95% CI 0.58-2.02). A Korean national database study of about 307,000 knee replacements found that Parkinson disease diagnosed before surgery was associated with a slightly higher 5-year hazard of cerebrovascular events (adjusted HR 1.11, 95% CI 1.07-1.16) but not periprosthetic fracture or infection, and the authors advise against routine vascular screening on this basis. A retrospective cohort of 297 robotic-assisted knee replacements found that moving two Coronal Plane Alignment of the Knee phenotypes (n = 19) was associated with smaller early Oxford Knee Score gains. In a propensity-matched cohort of 258 hip arthroscopies, interportal and T-capsulotomy with closure gave similar outcomes and 98% reoperation-free survival at two years.
Primary arthroplasty gave better early function and fewer reoperations than fixation alone in older adults with acetabular fractures
For older adults with comminuted acetabular fractures or joint impaction, consider discussing primary arthroplasty at a specialist meeting rather than defaulting to fixation.
Parkinson disease before knee replacement: a small rise in cerebrovascular events, not in infection
Counsel patients with Parkinson disease about a small excess in vascular events after knee replacement and consider medical review in selected cases, without routine screening.
Moving two knee phenotypes in robotic knee replacement was linked to smaller early gains
Consider auditing how far your robotic alignment moves the native phenotype, without treating a single threshold as established.
Give Parkinson medication on time around surgery
Treat Parkinson medication as time-critical in the perioperative period.
Interportal and T-capsulotomy gave comparable results at two years in hip arthroscopy
Consider interportal capsulotomy with closure when T-capsulotomy exposure is not needed, since outcomes were comparable in this cohort.
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