Aims The number of revision arthroplasties being performed in the elderly is expected to rise, including revision for infection. The primary aim of this study was to measure the treatment success rate for octogenarians undergoing revision total hip arthroplasty (THA) for periprosthetic joint infection (PJI) compared to a younger cohort. Secondary outcomes were complications and mortality. Methods Patients undergoing one- or two- stage revision of a primary THA for PJI between January 2008 and January 2021 were identified. Age, sex, BMI, American Society of Anesthesiologists grade, Charlson Comorbidity Index (CCI), McPherson systemic host grade, and causative organism were collated for all patients. PJI was classified as 'confirmed', 'likely', or 'unlikely' according to the 2021 European Bone and Joint Infection Society criteria. Primary outcomes were complications, reoperation, re- revision, and successful treatment of PJI. A total of 37 patients aged 80 years or older and 120 patients aged under 80 years were identified. The octogenarian group had a significantly lower BMI and significantly higher CCI and McPherson systemic host grades compared to the younger cohort. Results The majority of patients were planned to undergo two- stage revision, although a significantly higher proportion of the octogenarians did not proceed with the second stage (38.7% (n = 12) vs 14.8% (n = 16); p = 0.003). Although there was some evidence of a lower complication rate in the younger cohort, this did not reach statistical significance (p = 0.065). No significant difference in reoperation (21.6% (n = 8) vs 25.0% (n = 30); p = 0.675) or re- revision rate (8.1% (n = 3) vs 16.7% (n = 20); p = 0.288) was identified between the groups. There was no difference in treatment success between groups (octogenarian 89.2% (n = 33) vs control 82.5% (n = 99); p = 0.444). Conclusion When compared to a younger cohort, octogenarians did not show a significant difference in complication, re- revision, or treatment success rates. However, given they are less likely to be eligible to proceed with second stage revision, consideration should be given to either single- stage revision or use of an articulated spacer to maximize functional outcomes.

Aims: Femoral periprosthetic fractures are rising in incidence. Their management is complex and carries a high associated mortality. Unlike native hip fractures, there are no guidelines advising on time to theatre in this group. We aim to determine whether delaying surgical intervention influences morbidity or mortality in femoral periprosthetic fractures. Methods: We identified all periprosthetic fractures around a hip or knee arthroplasty from our prospectively collated database between 2012 and 2021. Patients were categorized into early or delayed intervention based on time from admission to surgery (early = ≤ 36 hours, delayed > 36 hours). Patient demographics, existing implants, Unified Classification System fracture subtype, acute medical issues on admission, preoperative haemoglobin, blood transfusion requirement, and length of hospital stay were identified for all patients. Complication and mortality rates were compared between groups. Results: A total of 365 patients were identified: 140 in the early and 225 in the delayed intervention group. Mortality rate was 4.1% at 30 days and 19.2% at one year. There was some indication that those who had surgery within 36 hours had a higher mortality rate, but this did not reach statistical significance at 30 days (p = 0.078) or one year (p = 0.051). Univariate analysis demonstrated that age, preoperative haemoglobin, acute medical issue on admission, and the presence of postoperative complications influenced 30-day and one-year mortality. Using a multivariate model, age and preoperative haemoglobin were independently predictive factors for one-year mortality (odds ratio (OR) 1.071; p < 0.001 and OR 0.980; p = 0.020). There was no association between timing of surgery and postoperative complications. Postoperative complications were more likely with increasing age (OR 1.032; p = 0.001) and revision arthroplasty compared to internal fixation (OR 0.481; p = 0.001). Conclusion: While early intervention may be preferable to reduce prolonged immobilization, there is no evidence that delaying surgery beyond 36 hours increases mortality or complications in patients with a femoral periprosthetic fracture. Cite this article: Bone Jt Open 2024;5(6):452–456.

Background. Irritable bowel syndrome (IBS) is a common chronic gut-brain interaction disorder with limited effective treatment options. Intestinal adsorbents have a high adsorption capacity for gut irritants and may provide nonpharmacological alternatives. Objectives. This post marketing study is aimed at providing up-to-date evidence to support the safety and efficacy in normal use of an established medical device for IBS treatment. Methods. In this open-label, observational study, adults with IBS with predominant diarrhoea (IBS-D) or IBS with mixed bowel habits (IBS-M), according to Rome IV criteria, received 4 weeks of treatment with the enteroadsorbent Silicol®gel, a CE-certified, licenced, medical device containing colloidal silicic acid. Eligible participants were assessed at baseline (visit 1; in-clinic) and after 1 (visit 2; telephone), 2 (visit 3; telephone), and 4 (visit 4; in-clinic) weeks of treatment. The primary endpoint was the proportion of participants with an overall reduction in the IBS severity scoring system IBS SSS > 50 , representing clinically meaningful improvement. Key secondary endpoints were a reduction in common IBS symptoms and improved quality of life (QoL). Results. Among the 67 treated participants (IBS-D: 37; IBS-M: 30), 65 completed the study. At visit 4, 83.6% (56/67) of participants achieved a reduction in IBS SSS > 50 . The mean (standard deviation [SD]) IBS SSS was 323.4 (55.7) at visit 1 and 160.3 (90.3) at visit 4 (overall change: -163.1 (101.7); 95% confidence interval [CI] 138.3, 187.9, p < 0.001 ). Compared with visit 1, significant reductions in the severity of all key IBS symptoms and overall improvement in QoL were observed at visit 4 ( p < 0.001 ), with improvements observed from visits 1 and 2. Conclusions. In this open-label study of participants with IBS-D and IBS-M, Silicol®gel provided clinically significant improvement in IBS symptoms, demonstrating that enteroadsorbents may be clinically beneficial in this population.

The mean TOI-14 was 48.22 (SD 10.10).• The mean HALT was 45.80 (SD 22.22).• There was a significant correlation between the TOI-14 and HALT,r = 0.605, p<0.001.• This is the first evidence that patients with poor quality of life due to sore throat also have poor quality of life due to halitosis.• It is currently unknown if the HALT score is modified by tonsillectomy.

To measure the impact of periods on the lives of women reporting a problem, through the use of health related quality of life instruments in a real-world setting. The evaluation was conducted throughout the UK using the web-based PROBE system (patient reported outcomes based evaluation). As women may not seek professional health care advice for this issue, recruitment was tailored to identify a sample representative of all women with problem periods. An initial screening questionnaire was used to programme the timing of the questionnaires (main evaluation). Questionnaires were completed around menstruation and mid-cycle in the same individual. Outcome measures included demographic data, symptoms, previous treatments, current medications, absenteeism, presenteeism, HRQoL using SF-36 and EQ-5D. Women with irregular periods or bleeding were not invited to the main evaluation due to difficulty timing questionnaire completion. A total of 2699 women participated in the screening questionnaire. 61% of screened women were under 30 years, half had sought medical advice and 25% were currently self-medicating for their periods. Patients were severely affected as noted on the following measures. Symptoms: 84% report physical symptoms, 78% psychological symptoms and 41% bleeding issues. Absenteeism: 21% take > 1-2 days off per month due to their period. Presenteeism: 33% reduction in workplace performance versus referent populations. 331 women participated in the main evaluation. From this, there was a significant difference in HRQoL between the worst and best times of the menstrual cycle: EQ5D questionnaire 0.57 to 0.76 (difference 0.167, p<0.001); EQ5D VAS 64.3 to 77.7 (difference 11.0, p<0.001); SF6D 0.61 to 0.72 (difference 0.1, p<0.001). This evaluation shows that women suffering from problem periods have a significant impairment of their QoL and productivity in spite of treatment. A need exists for treatment that can alleviate these symptoms, enable more productive lives and improve the overall quality of life in these women.

OBJECTIVE: To assess the efficacy of transobturator tapes in the management of women with urodynamic mixed urinary incontinence (UI).STUDY DESIGN: A secondary analysis of a prospective randomized study; 83 women with mixed UI on urodynamics and predominant stress UI symptoms were recruited and randomly assigned to undergo "outside-in" or inside-out transobturator tapes. Preoperative assessment included urodynamic assessment and completion of validated symptom severity and quality of life (QoL) questionnaires. The primary outcome was patient-reported success rates at 1-year as assessed by the Patient Global Impression of Improvement (very much/much improved). Secondary outcomes included changes in preoperative urgency/urgency incontinence, changes in QoL scores and comparison between the 2 types of transobturator tapes.RESULTS: Seventy-seven women completed 1-year follow-up (outside-in [n = 42] vs inside-out [n = 35]). The patient-reported success rate and objective cure rate were 75% and 90%, respectively. At 1-year follow-up; 40 women (52%) and 31 women (57.4%) reported cure in their preoperative urgency and urgency incontinence, respectively. A total of 74% reported >= 10 point improvement in QoL scores.CONCLUSION: In women with urodynamic mixed incontinence and predominant stress UI, transobturator tapes were associated with good patient-reported success rate at 1 year. Urgency/urgency incontinence are cured in over 50% of women.

EDITOR—I concur with Wright et al's unease about polypharmacy.1 Consultants with narrower interests simply bolt on their particular care package if the …

Seven techniques of gluteus medius attachment were compared in vitro in a canine model. Four methods were used for tendon to tendon attachment: (a) two modified Bunnell-Mayer sutures, (b) two Kessler locking loop sutures, (c) two horizontal mattress sutures, and (d) two sutures with a looped suture technique. The two methods of tendon to bone attachment were repair with a 1 cm spiked staple and repair with a spiked washer and screw, and the method of bone to bone attachment involved two figure-eight cerclage wires. The contralateral limb served as a control. Compared with the bone to bone attachment, the four tendon to tendon attachments and the two tendon to bone attachments had significantly less strength (31 and 30% of the ultimate load for bone to bone repair, respectively) and tensile stiffness (24 and 39% of the tensile stiffness for bone to bone attachment, respectively) (p < 0.0001). The control specimens were significantly stronger and stiffer than all specimens (p < 0.05) except those that had bone to bone fixation. There were no significant differences among the four tendon to tendon suture repairs with regard to either strength or stiffness; the values ranged from 28-45% of those of the controls. Among the tendon to bone repairs, fixation with a spiked washer and screw was significantly stronger than that with a spiked staple (p = 0.032), but there was no difference between these two techniques with regard to stiffness.

A descriptive profile of 106 pregnant women with various forms of cervicitis and vaginitis is provided. Fifty women attending individual physicians' private offices are compared with 56 clinic patients: 34 attending a university prenatal teaching clinic and 22 attending a pregnancy termination unit. Univariate analysis showed that single women were significantly more likely to be infected by mycoplasmas, yeasts, trichomonads, and Gardnerella vaginalis than were married women. Teenagers were more frequently infected by Mycoplasma hominis, yeasts, and Trichomonas vaginalis than were women older than 20 years. After stepwise logistic regression analysis, the most significant predictor of infection with M. hominis, Ureaplasma urealyticum, or yeasts was being a clinic patient; for G. vaginalis, the most significant variable was being unmarried. These data suggest that teenaged and single women who are pregnant will benefit most from routine screening for vaginitis/cervicitis-producing microorganisms.