This educational review outlines the core principles of humeral shaft fracture (HSF) management and is designed for orthopedic trainees, general orthopedic surgeons, emergency physicians, and allied health professionals who participate in the acute or postoperative care of patients with HSFs. The content integrates the authors' expert opinion with the current evidence. Humeral shaft fractures account for 1-3% of adult fractures, most often resulting from low-energy falls in older adults or high-energy trauma in younger patients. Although open fractures and neurovascular injuries are rare, primary radial nerve palsy (RNP) occurs in about 10% of cases. Diagnosis relies primarily on clinical evaluation and standard radiographs, with CT or MRI reserved for complex or pathological cases. Functional bracing has traditionally been the mainstay of nonsurgical treatment, achieving good long-term results but with nonunion rates up to 25%. Surgical fixation methods-including open reduction and internal fixation, minimally invasive plate osteosynthesis, and intramedullary nailing-allow earlier mobilization and more predictable fracture union but carry risks of iatrogenic RNP and infection. Management of primary RNP remains largely nonsurgical, with over 90% recovering spontaneously. Nonunion is frequently symptomatic and managed most often with compression plating. Surgery offers faster early recovery and lower nonunion rates, although long-term outcomes converge with successful bracing. Cost-effectiveness analyses suggest surgery may be more economical when productivity loss is considered, particularly for working-age patients. Optimal treatment selection depends on patient age, activity level, fracture characteristics, and patient preference, emphasizing shared decision-making.
Distal radius fractures in adults primarily occur in the elderly, in whom comorbidity, polypharmacy, dependency, and limited functional demands often coexist. Most patients have been managed non-surgically with casting. However, only a few trials with high evidence exist on comparing non-surgical and surgical treatments in the elderly. Given the heterogeneity of the aging population, a universal approach to treatment selection may not be feasible. This educational article aims to discuss the advantages and disadvantages of non-surgical vs surgical management, radiological assessment, complication risks, and osteoporosis screening. Moreover, we suggest surgical technical tips, a treatment algorithm, and a decision-making strategy that considers both functional demands and individual needs.
Info — Since early 2025, Acta Orthopaedica has served as the official publisher of the International Society of Arthroplasty Registries (ISAR) congresses. Founded in 2005, ISAR (https://www.isarhome.org) is a global organization comprising national, regional, and institutional joint replacement registries. Its mission is to improve outcomes for patients undergoing joint replacement surgery worldwide. Since 2012, ISAR has organized annual congresses featuring register-based research. Following the 14th International Congress of Arthroplasty Registries, held in Christchurch, New Zealand, presenters were invited to submit their work to Acta Orthopaedica. Over the past year, this initiative has resulted in 13 publications covering a broad range of topics. This partnership has been extended, looking ahead to the 15th congress held in Lund May 30 to June 1, 2026. Presenters at the Lund Congress are welcomed to submit their studies to Acta Orthopaedic with a deadline of October 1, 2026.
RCTs are a key block in the evidence pyramid, but their quality relies on detailed, consistent reporting, and one best-practice standard is prospective registration. Prospective trial registration was intended to reduce publication bias, and adherence to a prespecified protocol helps limit bias from selective reporting; any protocol or end point changes should be transparently documented and justified. However, the degree to which articles published in the leading journals on orthopaedic surgery comply with this best-practice standard has, to our knowledge, not been evaluated. (1) Do RCTs published in leading, general-interest orthopaedic surgery journals comply with best practices regarding prospective clinical trial registration? (2) Do major discrepancies exist between registered protocols and published orthopaedic RCTs? (3) Are there specific study types that are more likely to demonstrate discrepancies? A review was performed on RCTs published in the top five general-interest orthopaedic surgery journals, based on the 2022 scientific journal rankings (from SciMago): Journal of Bone and Joint Surgery, Bone and Joint Journal, Clinical Orthopaedics and Related Research®, Journal of the American Academy of Orthopaedic Surgeons (JAAOS), and Acta Orthopaedica. During the study period, all journals maintained editorial policies requiring prospective clinical trial registration as a condition of consideration for publication except for JAAOS. A systematic search on PubMed retrieved 705 potential publications, of which 324 RCTs fulfilled the inclusion criteria. For each trial, nine essential elements from the 24-item WHO minimum data set were extracted and compared between the published article and its trial registry entry, focusing on health condition, intervention, sample size, outcomes, and eligibility criteria. To answer our first question regarding compliance, we audited each article to identify the presence of a registry code. For our second question, we performed a side-by-side comparison of nine essential elements from the WHO trial registration data set (including primary outcomes, sample size, and eligibility criteria) to identify discrepancies between the registry and the final publication. Finally, to address our third question, we used chi-square tests to determine whether study characteristics, such as country of origin or subspecialty, were associated with higher rates of reporting shifts. Most orthopaedic RCTs published in leading journals complied with registration standards, with 95% (309 of 324) having an identifiable registry entry. However, 2% (8 of 324) were published without any registry identifier or justification for its absence, and 2% (7 of 324) were identified as long-term follow-up visits that did not have unique prospective entries. Major discrepancies between registered protocols and published manuscripts were frequent. Discrepancies in the sample size occurred in 33% (102 of 309) of trials. Discrepancies in the primary outcome occurred in 25% (78 of 309) of trials. Discrepancies in the secondary outcome occurred in 60% (185 of 309) of trials. Discrepancies in the inclusion criteria occurred in 33% (102 of 309) of trials. Discrepancies in the exclusion criteria occurred in 53% (165 of 309) of trials. Trials conducted in the United States or as multicenter international collaborations were more likely to update their final results in the registry compared with single-country trials conducted outside the US (37% versus 10%; p < 0.001). No other study characteristics, including publication year or subspecialty, were associated with the presence of reporting discrepancies. Prospective registration has become the standard for RCTs in high-impact orthopaedic journals. However, our findings suggest that a gap still exists between having a registry and the accuracy of the information contained within it. These findings suggest that registration is often treated as a procedural requirement rather than a rigorous commitment to a fixed study protocol. The orthopaedic research community should adopt stricter standards for trial registration, reporting, and verification of registry entries to reduce undisclosed protocol changes and improve confidence in published evidence.
The Masquelet technique is a 2-stage surgical method used for the reconstruction of critically sized bone defects due to various etiologies. Estrogen is known to have anabolic effects on bone metabolism. In this study, based on literature data, the aim is to systematically evaluate the histological and immunohistochemical effects of adding different doses of estrogen to polymethylmethacrylate cement on induced membrane tissue.  Methods: Twenty-eight male rats were included in the study and divided into 4 groups. Three experimental groups received different doses of estradiol, a subtype of estrogen mixed with bone cement, while a control group received only bone cement. Approximately 10 mm defects were created in single femurs of all rats. Bone cement appropriate for each experimental group was placed in these defects, and bone fixation was performed with mini plates and screws. Tissue samples taken from all animals at the end of the sixth week were evaluated by histological and immunohistochemical methods.  Results: Histological and immunohistochemical evaluations of the induced membranes obtained at the end of the experiment revealed signs of bone formation in all subgroups. A significant increase in bone formation was observed with increasing doses in groups E1, E2, and E3 compared to the control group (P < .05). The histological scores of the study groups were found to increase statistically significantly with increasing estrogen dose (P < .05). Furthermore, immunohistochemical analyses revealed that the immuno-reactive scores for bone morphogenetic protein-4 and insulin-like growth factor-1 expression were significantly higher in the E3 group compared to the other groups (P < .05).  Conclusion: In this study, it was found that enriching the cement content with estrogen during bone cement placement, the first step of the Masquelet technique, improved the quality of the formed membrane. This improvement in membrane quality is promising for increasing treatment efficacy and shortening the treatment duration.    Cite this article as: Çiftçi MU, Purelku M, Özönder F, et al. Dose-dependent effects of estrogen-enriched bone cement on membrane quality in the masquelet technique: experimental rat model. Acta Orthop Traumatol Turc., 2026; 60(1), 0355, doi: 10.5152/j.aott.2026.25355.
The purpose of this study was to define the prevalence of os acromiale on magnetic resonance imaging (MRI) in patients presenting with shoulder pain, to document how often it coexists with rotator cuff tears, and to assess whether focused review detects this variant more reliably than routine radiology reporting.  Methods: A retrospective review was conducted on 3697 shoulder MRI examinations obtained between 2020 and 2025 at a tertiary referral center. All studies were independently evaluated by 2 fellowship-trained shoulder surgeons and 1 musculoskeletal radiologist, focusing specifically on the presence, subtype, and coexistence of os acromiale with rotator cuff pathology. Interobserver reliability was assessed using Cohen's kappa coefficient, and findings were compared with the original radiology reports.  Results: Os acromiale was identified in 26 cases, corresponding to a prevalence of 0.7%. Only 11 cases were mentioned in the original radiology reports. Interobserver agreement between shoulder surgeons was almost perfect (κ = 0.98) and excellent between surgeons and the radiologist (κ = 0.92). Subtypes included 12 preacromion, 13 mesoacromion, and 1 metaacromion. Rotator cuff tears were present in 20 of 26 patients with os acromiale (77%), including isolated supraspinatus tears (n = 9), combined supraspinatus-infraspinatus tears (n = 4), supraspinatus-subscapularis tears (n = 3), massive tears (n = 2), and cuff tear arthropathy (n = 2).  Conclusion: Os acromiale was uncommon in this MRI-based cohort but frequently coexisted with full-thickness rotator cuff tears. Although causality cannot be inferred, this coexistence may carry clinical relevance. Notably, focused evaluation documented more cases than routine radiology reports, underscoring the added value of targeted assessment.       Cite this article as: Birsel O, Yığman GT, Günerbüyük C, Baş A, Chodza M, Eren İ. Prevalence of os acromiale and concomitant rotator cuff tears: a focused assessment of 3697 shoulder magnetic resonance imagings. Acta Orthop Traumatol Turc. 2026; 60(1), 0714P doi: 10.5152/j.aott.2026.25714.
Shared decision-making (SDM) is important in managing patients with severe hip and knee osteoarthritis, where treatment decisions often depend on patient preferences and values. We aimed to evaluate the effectiveness of an in-consult patient decision aid in improving decision quality and patient involvement compared with usual care. In a cluster-randomized controlled trial, surgeons from 2 Danish orthopedic departments were randomized to use in-consult patient decision aids or provide usual care. The primary outcome was decision quality assessed using the Hip/Knee OA Decision Quality Instrument (HK-DQI). Patients who were well informed and received their preferred treatment received an Informed Patient-Centered (IPC) score of 1, indicating good decisional quality; all others scored 0. Secondary outcomes included patient-experienced engagement and involvement in decision-making, assessed using CollaboRATE and the decision-process domain of the Hip/Knee OA Decision Quality Instrument and consultation duration. Relative risks (RR) and mean differences (MD) with 95% confidence intervals (CIs) were estimated using multilevel regression models. 20 surgeons were randomized to either use in-consult patient decision aids (n = 10) or provide usual care (n = 10). Of the 1,038 patients screened for severe hip or knee osteoarthritis, 581 were included in the study. Decision quality was similar between groups, with a score of 43 (36-51) in the intervention group and 44 (37-52) in the usual care group (RR 0.9, CI 0.7-1.2; P = 0.8), likewise, patient-experienced engagement assessed with CollaboRATE (RR 1.1, CI 0.8-1.4; P = 0.6). Consultations were longer in the intervention group, with a mean difference of 3.9 minutes (CI 0.1-7.7; P = 0.04). Decision quality and patient-reported engagement were similar between groups, while consultation time was longer with in-consult patient decision aids use. In the absence of prespecified minimal important differences, the clinical relevance of these findings remains uncertain.
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 Hip migration is a common complication in children with cerebral palsy (CP). Although spasticity has long been considered a contributing factor, muscle-specific associations with hip migration remain unclear. We aimed to investigate whether assessed hip spasticity was associated with hip displacement risk in non-ambulant children with CP.  In this population-based cohort study using Danish Cerebral Palsy Follow-Up Program (CPOP) data, children classified as Gross Motor Function Classification System (GMFCS) levels IV-V with at least 1 hip radiograph were included. Pathological hip migration was defined as migration percentage (MP) ≥ 30%. Spasticity was assessed using the Modified Ashworth Scale (MAS) for hip adductors, flexors, and extensors. Overall hip spasticity was defined as summed MAS (0, 1-3, 4-6, 7-9). Cumulative incidence was estimated with death as a competing event, and associations were evaluated using Fine-Gray regression adjusted for GMFCS level. 422 children (786 hips) were included; 374 hips (48%) reached MP ≥ 30%, and death occurred as a competing event in 16 patients (25 hips). Higher overall hip spasticity was associated with increased risk of hip migration, with subdistribution hazard ratios (sHRs) of 1.46 (CI 1.05-2.01), 1.77 (CI 1.22-2.58), and 2.53 (CI 1.59-4.02) for MAS 1-3, 4-6, and 7-9, respectively, compared with MAS 0. Adductor spasticity showed the most consistent association with sHRs ranging from 1.44 to 1.97 across MAS categories.  In children with CP classified as GMFCS levels IV-V, higher clinically assessed hip spasticity-particularly of the hip adductors-was associated with development of a hip at risk for displacement.
Inducible displacement CT (ID-CT) is an emerging method for diagnosing implant loosening by (i) acquiring CT scans under different joint loading conditions, (ii) analyzing scans via segmentation and registration, and (iii) quantifying and visualizing relative implant-bone displacement. With multiple centers approaching these steps differently, this scoping review aimed to summarize current methodologies and key challenges. PubMed, Cochrane, and Embase were searched for clinical and experimental ID-CT studies on spinal and arthroplasty implants. Data was extracted using a table based on updated CT-radiostereometric analysis (RSA) guidelines, including study characteristics, CT acquisition parameters, image analysis methods, validation approaches, outcomes, and loading protocols. Diagnostic studies were assessed with QUADAS-2. 22 studies were included concerning the hip (10), knee (7), spine (4), and wrist (1), covering clinical and experimental (phantom and cadaveric) designs. Loading protocols varied widely, applying compressive, rotational, and angular forces with external stabilization or loading devices. CT acquisition ranged from µCT to conventional and weight-bearing CT, with variation in kVp, mAs, reconstruction spacing, and metal artefact reduction. Image-analysis workflows were broadly similar, though reporting of algorithms and displacement metrics was often incomplete. Diagnostic validation was limited by variable reference standards, non-prespecified loosening thresholds, and non-blinded assessments, undermining true performance. Technical validation, although often precise, did not cover the full ID-CT pipeline (i.e., complete loading protocol), leaving key sources of measurement variance untested. We showed that ID-CT is used with a wide variation in approach and limited reporting prevents the establishment of its true diagnostic accuracy.
 Stiffness after total knee arthroplasty (TKA) is a common early complication and multiple risk factors are recognized. We aimed to investigate the risk factors for manipulation under anesthesia after primary TKA and for the subsequent revision TKA in patients requiring manipulation using national healthcare registers.  We used the comprehensive register data of the PERFECT project that included data from the Finnish arthroplasty register (FAR) and the Care Register of Health Care (CRHC). We excluded patients under 40 years old. The Aalen-Johansen estimator and Cox proportional hazards regression model were used in the risk assessment.  154,883 patients had primary TKA in Finland in 1999-2020 , of which 3,861 patients required manipulation within 1 year of primary TKA. The 1-year cumulative incidence of manipulation was 2.5%. In the multivariable analysis, female sex (hazard ratio [HR] 1.53, CI 1.42-1.64), diabetes mellitus (HR 1.19, CI 1.08-1.31), coronary artery disease (HR 1.25, CI 1.12-1.39), and hypercholesterolemia (HR 1.16, CI 1.06-1.28) were associated with an increased risk of manipulation. Increasing age was associated with a decreased risk of manipulation (multivariable HR 0.94 per year, CI 0.94-0.94). Patients requiring manipulation within 1 year of primary TKA had a significantly increased risk of revision TKA (HR 2.26, CI 2.05-2.50). The 10-year cumulative risk of revision TKA after manipulation was 15% (CI 14-16).  Manipulation was more likely to be performed for females, relatively younger patients, and patients with diabetes mellitus, coronary artery disease, or hypercholesterolemia. Patients who had manipulation within 1 year of primary TKA had an increased risk of revision with a 10-year cumulative risk of revision of 15%.
Injuries after primary total hip arthroplasty (THA) can be compensated through the National Swedish Patient Insurance Company (Löf). This study examined injury incidence, types, consequences, and subgroup differences in compensated claims following primary THA for osteoarthritis (OA) in Sweden over 10 years. Data from Löf and the Swedish Arthroplasty Register were used for compensated claims following primary THA between 2012 and 2021. Injury incidence and subgroup differences by sex, age, OA diagnosis, and surgical volume were analyzed. Injury types, severity, reoperation rate, and surgical approach were evaluated. Absolute risk differences (ARD) and incidence rate ratios (IRR) were calculated. 1,343 injuries were followed up. The injury incidence was 1.3%. Injury rates were higher in patients < 65 years than ≥ 65 years (ARD 0.2%, 95% confidence interval [CI] 0.1-0.3), in OA due to hip dysplasia compared with primary OA (IRR 1.78, CI 1.31-2.35), and at low- and medium-volume compared with high-volume hospitals (IRR 1.35, CI 1.11-1.64; IRR 1.27, CI 1.14-1.42). In surgery-related injuries (n = 1,251), infection (38%, CI 35-41) and nerve injury (22%, CI 20-25) were the most common injury types, and direct lateral incisions were more frequent than national reference proportions of all THAs during the study period (ARD 9%, CI 6-12). Permanent disability occurred in 74% (CI 72-77) of the claims, and the 2-year reoperation rate was 51% (CI 48-54) (0.4% of the total population). The injury incidence after primary THA was 1.3% and frequently resulted in permanent disability and reoperation. Infection and nerve injury were the most common injury types. Higher injury rates in younger patients, hip dysplasia, and lower-volume hospitals highlight potential areas for prevention and increased awareness.
Postoperative mobilization may influence the outcome following hip fracture. We aimed to examine whether regaining pre-fracture basic mobility on discharge is associated with subsequent risk of reoperation and mortality. Using nationwide Danish registries, we identified 33,486 patients ≥ 65 years who underwent hip fracture surgery between January 2016 and November 2021. Pre-fracture and discharge mobility were assessed with the Cumulated Ambulation Score (CAS, score 0-6 where 6 is best ambulation). The exposure was regaining pre-fracture CAS at discharge. Adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs) for reoperation and mortality up to 365 days were estimated using Cox regression, adjusting for age, sex, surgery year, length of stay, and comorbidities. On discharge, 19,329 patients (65%) had not regained pre-fracture CAS. The 30-day reoperation risk was similar among patients who had not regained CAS (2.9%) and those who had (2.5%; aHR 1.10, CI 0.94-1.29). At 365 days, not regaining CAS was associated with a lower reoperation risk (7.1% vs 8.6%; aHR 0.98, CI 0.89-1.07). A CAS loss of 1-2 points was associated with an increased 30-day reoperation risk (aHR 1.20, CI 1.00-1.44). CAS decline was consistently associated with higher mortality at 30 days (aHR 2.07, CI 1.82-2.35) and 365 days (aHR 1.77, CI 1.66-1.89), with progressively higher rates at greater CAS decline. We found no consistent association between failure to regain pre-fracture mobility on discharge and reoperation, although patients with a 1-2 point CAS loss experienced a modestly higher 30-day reoperation risk. In contrast, failure to regain pre-fracture mobility was strongly associated with increased mortality up to 1 year after hip fracture.
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Previous reports on incidences rates of Scandinavian pediatric extremity fractures have varied, as they are often anatomically specific and based on institution-specific findings. To gain knowledge of current and future burden on the healthcare system, a national cohort assessment is necessary. We aimed to assess the proportion and incidence within anatomical distributions of pediatric extremity fractures in relation to age, sex, and time trends. We retrieved a 20-year population-based cohort from the Danish National Patient Registry 1999-2018. We included all children aged 0-15 years with an extremity fracture diagnosis (ICD-10). We estimated fracture proportions and incidence rates (IRs) in different anatomical regions stratified by sex, age groups, and periods. IRs were estimated based on national population counts. We included 668,595 pediatric fractures corresponding to an overall IR of 3,164 (95% confidence interval 3,157-3,172) per 100,000 persons/year. The highest proportion and IR were in the lower arm, but the proportions differed within the age groups. The IR increased with age and was higher in boys. The overall IR increased during the study period. In upper and lower leg fractures a decrease was seen, with all other anatomical sites increasing. We found an increased IR during the study period for all fractures except for the upper and lower leg. The study gives important knowledge to the healthcare system when coordinating the right resources.
Medical devices commonly employed in orthopedic surgery continue to be susceptible to challenging and costly biofilm bacterial infections. We aimed to evaluate the impact of mechanical brushing with sonication and radiofrequency on biofilms grown on 3 metallic alloys commonly utilized in orthopedic implants: titanium, stainless steel, and cobalt-chromium. Biofilms of 4 common bacteria encountered in orthopedic infections were grown on 540 metal chips for 3 metal alloy cohorts. The biofilms were treated with sterile saline irrigation, sonication brushing, or radiofrequency sonication brushing to compare against untreated control. Biofilm burden was evaluated both qualitatively and quantitatively with scanning electron microscopy imaging and crystal violet (CV) staining optical density or colony-forming unit measurements, respectively. Parametric, nonparametric, and linear regression analyses for quantitative data were performed. Qualitatively and quantitatively, all interventions showed a strong reduction in biofilm burden of all microbes on all metals. There was a significant decrease in CV-stained biofilms for brushing interventions compared with irrigation alone and controls. Biofilm burden was significantly reduced in all experiments. The untreated control represented 100% biofilm. Irrigation alone reduced biofilm to 44%, while sonication further decreased biofilm to 25%. The most effective method, sonication with radiofrequency, reduced biofilm to 20%. Our data shows consistent qualitative and quantitative reduction in biofilm burden with brushing interventions compared with irrigation and control. While further study is warranted, our data suggest that mechanical brushing with sonication and radiofrequency may be beneficial tools in reducing biofilm burden on orthopedic metal implants.
Patient satisfaction after total hip and knee arthroplasty (THA, TKA) is influenced by multiple factors, including patient-reported pain and function. We aimed to examine whether functional abilities or pain during specific activities are associated more than other aspects with satisfaction 1 year after THA and TKA. This cohort study included all primary elective THAs and TKAs performed between January 2012 and June 2022 at a tertiary care university hospital. Ordinal logistic regression models were used to assess associations between patient satisfaction and WOMAC Pain and Function summary scores and items, 1 year postoperatively. 1,772 THAs and 1,323 TKAs were included. Individually, all scores and items were associated with satisfaction. However, multivariable models revealed differences in the strength of association. Global pain score (odds ratio [OR] THA: 2.80, 95% confidence interval [CI] 2.40-3.29; TKA: 3.61, CI 2.96-4.44), pain while walking on the flat (OR THA: 1.79, CI 1.45-2.22; TKA: 1.74, CI 1.43-2.11), and pain going up or down stairs (OR THA: 1.64, CI 1.37-1.96; TKA: 1.68, CI 1.44-1.97) showed the strongest associations in both populations. Among THAs, activities walking on the flat (OR 1.41, CI 1.17-1.68), putting on socks (OR 1.29, CI 1.12-1.48), and ascending stairs (OR 1.26, CI 1.08-1.46) contributed most to satisfaction, whereas among TKAs, walking on the flat (OR 1.41, CI 1.18-1.69), rising from sitting (OR 1.32, CI 1.11-1.58), and getting in or out of a car (OR 1.31, CI 1.10-1.57) did. After THA/TKA, patient satisfaction is associated with pain during basic daily tasks-especially walking and stair climbing. Key functional drivers differ by joint: socks and stairs matter for THA, rising from sitting and getting in/out of a car matter for TKA.
Limited data exist on mortality and venous thromboembolism (VTE) risk in hip-fracture patients with recent COVID-19 infection. We aimed to examine (i) the association between vaccination status and mortality risk, (ii) whether infection timing is associated with mortality risk, and (iii) whether recent infection is associated with an increase in postoperative VTE risk. Adult Kaiser Permanente Northern California members undergoing hip-fracture surgery (2020-2022) were identified. Patients with varying vaccination statuses and SARS-CoV-2 infection histories within 6 months preoperatively were analyzed. Multivariable regression models were adjusted for demographics, comorbidities, and COVID-19 status to calculate risk ratios. The primary outcome was 90-day mortality; the secondary outcome was 90-day VTE. 3,674 patients were included. Unvaccinated or partially vaccinated patients with COVID-19 within 6 months preoperatively had a 4.49-fold higher 90-day mortality risk than fully vaccinated patients (95% confidence interval [CI] 3.72-5.42). Among COVID-positive patients, shortening of the interval from infection to surgery from 6 months to 6 weeks was associated with increased 90-day mortality risk of approximately 53% (CI 1.29-1.97). Additionally, more recent infection (within 6 months) was associated with a 3.14-fold higher postoperative VTE risk (CI 1.10-8.98). COVID-19 vaccination is associated with a reduction in the mortality risk among hip-fracture patients with recent infection. Shorter infection-to-surgery intervals are associated with increased mortality risk, and recent infection is associated with higher VTE risk.
The aim of this study was to investigate patient safety, defined using in-hospital complications, early readmissions, mortality, and days alive and at home (DAH), after day-case and non-day-case hip and knee arthroplasty in a public healthcare setting. This multicentre cohort study included consecutive patients who underwent primary total hip arthroplasty (THA), total knee arthroplasty (TKA), or unicompartmental knee arthroplasty (UKA) between September 2022 and May 2024. All eight public hospitals which were involved followed the same standardized protocol with consistent eligibility for day-case surgery and discharge criteria. Postoperative hospital contacts within 30 days were recorded using the patients' medical records and electronic questionnaires. Day-case surgery was defined as discharge on the day of surgery to the patient's own home. A total of 12,607 patients were included, of whom 3,159 (25%) were day-case and 9,430 (75%) were non-day-case patients. The mean length of hospital stay (LOS) was one day (0 to 70); 5% of patients (95% CI 4.9 to 5.5) had a LOS of > two days, primarily due to mobilization issues (1.4%) and pain (1.3%). The overall readmission rate was 0.5% (95% CI 0.4 to 0.7) within 48 hours and 4.4% (95% CI 4.1 to 4.8%) within 30 days. Readmission rates were 0.7% (95% CI 0.5 to 1.1) and 1.9% (95% CI 1.5 to 2.5) for day-case patients, and 0.5% (95% CI 0.3 to 0.6) and 5.3% (95% CI 4.8 to 5.8) for non-day-case patients within 48 hours and 30 days, respectively. When stratified by the type of surgery, there were only minor variations. No patients died within 48 hours, and the overall 30-day mortality was 0.08% (n = 10), with no deaths among day-case patients. The median DAH30 was 30 (IQR 30 to 30) for day-case patients and 29 (IQR 29 to 29) for non-day-case patients. These findings indicate that fast-track surgery with a one-day LOS and a 25% day-case rate in a national, publicly funded healthcare system is safe, based on low rates of in-hospital complications, early readmission, mortality, and a high DAH30.