I.

Background and purpose Patient-specific templating total knee arthroplasty (TKA) is a new method for alignment of a total knee arthroplasty that uses disposable guides. We present the results of the first 40 consecutive patients who were operated on using this technique.Methods In this case-control study, we compared blood loss, operation time, and alignment of 40 TKAs performed using a patient-specific templating alignment technique with values from a matched control group of patients who were operated on by conventional intramedullary alignment technique. Alignment of the mechanical axis of the leg and flexion/extension and varus/valgus of the individual prosthesis components were measured on standing, long-leg, and standard lateral digital radiographs. The fraction of outliers (> 3˚) was determined.Results Mean mechanical axis of templating TKAs was 181° with a fraction of outliers of 0.3, and mean mechanical axis of conventional TKAs was 179˚ (outlier fraction 0.5). Fraction of outliers in the frontal plane for femoral components was 0.05 in the templating TKAs and 0.4 in the conventional TKAs, and for tibial components the corresponding values were 0.2 and 0.2. In the templating TKAs and conventional TKAs, fraction of outliers in the sagittal plane was 0.4 and 0.9, respectively, for femoral components and 0.4 and 0.6 for tibial components. Mean operation time was 10 min shorter and blood loss was 60 mL less for templating TKA than for intramedullary-aligned TKAs.Interpretation Patient-specific templating TKA showed improved accuracy of alignment and a small reduction in blood loss and operating time compared to intramedullary-aligned TKA, but the fraction of outliers was relatively high. Larger RCTs are needed for further evaluation of the technique and to define the future role of patient-specific template alignment techniques for TKA.

BackgroundMalnutrition after hip fracture is associated with increased rehabilitation time, complications, and mortality. We assessed the effect of intensive 3 month nutritional intervention in elderly after hip fracture on length of stay (LOS).MethodsOpen-label, randomized controlled trial. Exclusion criteria: age < 55 years, bone disease, life expectancy < 1 year, bedridden, using oral nutritional supplements (ONS) before hospitalization, and cognitive impairment. Intervention: weekly dietetic consultation, energy-protein–enriched diet, and ONS (400 mL per day) for 3 months. Control: usual nutritional care. Primary outcome: total LOS in hospital and rehabilitation clinic, including readmissions over 6 months (Cox regression adjusted for confounders); hazard ratio (HR) < 1.0 reflects longer LOS in the intervention group. Secondary outcomes: nutritional and functional status, cognition, quality of life, postoperative complications (6 months); subsequent fractures and all-cause mortality (1 and 5 years). Effect modification by baseline nutritional status was also tested.ResultsOne hundred fifty-two patients were randomized (73 intervention, 79 control). Median total LOS was 34.0 days (range 4–185 days) in the intervention group versus control 35.5 days (3–183 days; plogrank = .80; adjusted hazard ratio (adjHR): 0.98; 95% CI: 0.68–1.41). Hospital LOS: 12.0 days (4–56 days) versus 11.0 days (3–115 days; p = .19; adjHR: 0.75; 95% CI: 0.53–1.06) and LOS in rehabilitation clinics: 19.5 days (0–174 days) versus 18.5 days (0–168 days; p = .82; adjHR: 1.04; 95% CI: 0.73–1.48). The intervention improved nutritional intake/status at 3, but not at 6 months, and did not affect any other outcome. No difference in intervention effect between malnourished and well-nourished patients was found.ConclusionsIntensive nutritional intervention after hip fracture improved nutritional intake and status, but not LOS or clinical outcomes. Paradigms underlying nutritional intervention in elderly after hip fracture may have to be reconsidered.

Case-control study, Level III.

Level II, randomized controlled trial.