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Here Were No Dislocations in Both Groups

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Here Were No Dislocations in Both Groups 1 Hip (including infection) 36 ARTIFICIAL INTELLIGENCE TO PREDICT PERIPROSTHETIC INFECTION AFTER TOTAL HIP REPLACEMENT Z. Arshad1, B. Davies1, A. Carr2, P. Walmsley3 1University of Cambridge, Cambridge, United Kingdom, 2University of Oxford, Oxford, United Kingdom, 3University of St Andrews, St Andrews, United Kingdom Background: The prevalence of peri-prosthetic joint infection (PJI) after THR is expected to rise in line with increasing prevalence of hip arthroplasty.This will be associated with significant morbidity to the patient, and cost to the healthcare provider. Treatment and diagnosis is difficult, making targeted prevention key. To facilitate this, we used artificial intelligence to build a tool to predict PJI within one year of a THR using variables that could be collected prior to operation. Methods: A retrospective analysis of prospectively collected data for 3349 patients who underwent a THR within Fife was undertaken. 15 predictor variables that could be collected during pre-operative outpatient clinics were included in the final analysis. These included clinical, demographic, and procedural factors. The random forests algorithm was trained and performance assessed using OOB metrics. Results: The overall accuracy was calculated as 93.1% (95% CI 88.8-97.4). Sensitivity and specificity were found to be 87.4% (95% CI 81.2-93.6) and 94.1% (95% CI 86.5-100.0), respectively. The positive and negative predictive values of the tool were 44% and 99.5%, respectively. The model highlighted that increases in SF-36 score, age, harris hip score, and serum hemoglobin decrease the probability of infection. BMI was positively associated with infection rate, however. Conclusions and Implications: Future work will involve externally validating the tool to assess its generalizability beyond the regional data used in this project. All predictor variables can be collected prior to operation with minimal cost to the healthcare provider. It could have clinical utility in risk- stratifying patients for follow-up, further confirmatory diagnosis and/or infection prevention protocols. It could also assist in the provision of informed consent by facilitating discussion with high-risk patients, in addition to providing reassurance to patients identified as low-risk of infection. Conflict of Interest: Nothing to disclose 39 SAFETY OF IN-HOSPITAL ONLY THROMBOPROPHYLAXIS AFTER FAST-TRACK TOTAL HIP AND KNEE ARTHROPLASTY - A PROSPECTIVE FOLLOW-UP STUDY IN 18,409 PATIENTS P.B. Petersen, H. Kehlet, C.C. Jørgensen Rigshospitalet, Section for Surgical Pathophysiology, Copenhagen, Denmark Background: Total hip and knee arthroplasty (THA/TKA) are considered high-risk procedures regarding venous thromboembolic events (VTE) including deep venous thrombosis (DVT) and pulmonary embolism (PE). Consequently, most guidelines recommend chemical thromboprophylaxis for 10-35 days postoperatively. However, reports on 90-days VTE rates of about 0.4% in fast-track THA and TKA with early mobilization led to suggestions of in-hospital only thromboprophylaxis in selected fast-track procedures, calling for additional follow-up studies. Methods: Prospective cohort study from 01 December 2011-30 October 2015 on elective unilateral THA/TKA with in-hospital only thromboprophylaxis if length of stay (LOS) ≤5 days. Prospective information on comorbidity and complete follow-up on 90-days readmissions/mortality through the Danish National patient registry. Discharge- and medical records evaluated in case of VTE. Patients preoperatively treated with anticoagulants were excluded. Results: Of 18,409 procedures, 17,562 (95.4%) had LOS ≤ 5 days, median LOS was 2 days (IQR 2- 3), 6.8% readmissions and 0.2% mortality rate. Mean age was 67.4 (10.5) years, 59% women and 52% THA. 90 days VTE incidence was 0.4%. In the 847 patients with LOS >5 days, median LOS was 7 days (6-9), 13.8% had readmissions, mortality was 1.5%, and VTE incidence was 2.1%. Risk factors for VTE in the early discharge cohort (LOS ≤ 5 days) were age > 85 years with OR 3.7 (95% CI; 1.2 to 12.1, p=0.029), BMI 35 to 40 with OR 2.6 (1.0 to 6.4, p=0.045) and > 40 with OR 3.3 (1.0 to 10.5, p=0.047). Conclusion: We found similar results as previously reported in a study of approximately 5000 patients, confirming the safety of in-hospital only thromboprophylaxis in fast-track THA and TKA with LOS ≤5 days. Implications: Guidelines on thromboprophylaxis in fast-track THA and TKA with a LOS ≤5 days may include in-hospital only prophylaxis. The ideal LOS or risk factors necessitating prolonged thromboprophylaxis remain uncertain. Conflict of Interest: Nothing to disclose 41 RESULTS OF TREATMENT OF DISPLACED FEMORAL NECK FRACTURES IN THE ELDERLY BY CEMENTED TOTAL HIP REPLACEMENT VERSUS DUAL MOBILITY CUP TOTAL HIP REPLACEMENT: FOCUS ON FUNCTIONAL OUTCOME AND HEALTH RELATED QUALITY OF LIFE R. Rashed1, H. Sevenoaks1, A. Shabaan2, M. Kasem3, T. Elkhadrawe3, M. Eldakhakhny3, Q. Choudry1 1Royal Blackburn Hospital, Blackburn, United Kingdom, 2Alexandria University, Physical Medicine, Alexandria, Egypt, 3Alexandria University, Alexandria, Egypt Introduction: It is documented in the literature that treating femoral neck fractures using a total hip replacement provides a better long term functional outcome for active elderly patients. Dislocation remains the main complication of this approach. The development of the dual mobility cup (DMC) hip replacements maybe a solution to such controversy, providing better stability and better range of motion and functional outcomes. Patients and methods: This study includes 62 patients with displaced femoral neck fractures, who were randomly allocated to 2 treatment groups, a DMC replacement group, and a 32 mm head THR. Posterior approach was use in all patients. The overall mean age was 67.2 years, and 48.8% were males. Postoperative assessment was done using Harris hip score, and health related quality of life (HRQoL) was assessed using the SF-36 questionnaire. Results: The average HHS for the DMC group at 4, 6 and 12 months were higher than mean HHS scores for the THR group. Those differences were statistically significant (p values 0.008, 0.001. and 0.000 respectively) The range of motion at 1 year was statistically better in the DMC group as compared to the THR group. Those differences were statistically significant. The DMC showed a statistically better effect on the HRQoL measurements as compared to the THR group. There were no dislocations in both groups. Conclusion: DMC hip replacements provide better functional, patient reported outcomes, and range of motion than the conventional THR. Combined with its stability, DMC replacements are a useful solution in managing femoral neck fractures in active elderly patients. Conflict of Interest: Nothing to disclose 93 A COMPARISON OF MORTALITY IN REVISION HIP ARTHROPLASTY FOR PERIPROSTHETIC FRACTURE, INFECTION OR ASEPTIC LOOSENING J. Barrow, H. Divecha, G. Hastie, H. Wynn-Jones, T. Board Wrightington Hospital, Centre for Hip Surgery, Appley Bridge, United Kingdom Background: Reported mortality following revision hip surgery for periprosthetic fracture is comparable to neck of femur fractures. Our institution provides a regional “Periprosthetic Fracture Service”. The necessity of patient transfer can introduce delays to surgery. The aim of this study was to determine the time to surgery and mortality rate for PPF, compared to a cohort revised for infection or aseptic loosening. Methods: Revision procedures performed for PPF, infection or aseptic loosening between January 2014 and December 2015 were identified. Comparisons were made between the three groups for baseline demographics, admission to higher-level care, length of stay, complications and mortality. Results: There were 37 PPF, 71 infected and 221 aseptic revisions. PPF had a higher proportion of females (65% vs 39% in infections and 53% in aseptics; p=0.031) and grade 3 and 4 ASA patients (p=0.006). Median time to surgery in the PPF group was 8 days (95% CI: 6-16). Single stage procedures were performed in 84% of PPF, 42% of infections and 99% of aseptic revisions (p< 0.0001). 19% of PPF revisions required admission to HDU, with 1% in the aseptic group and none in the infection group. Median length of stay was significantly different (PPF 10; infection 14; aseptic 8 days (p< 0.0001)). The 1-year mortality rate for PPF was 0% compared to 2.8% for infection and 0.9% in the aseptic group (p=0.342). Conclusion: Despite the PPF group having higher ASA grades and HDU admission, our 1-year mortality rate was 0% and not significantly different to infection or aseptic loosening. Further work is needed to monitor medium term outcomes and to establish the financial impact of our “Periprosthetic Fracture Service” service as it evolves. Implications: Our low complication and 1-year mortality rate is encouraging and supports the safety of a regional “Periprosthetic Fracture Service”. Conflict of Interest: Prof Board is a paid consultant for DePuy Synthes, receives royalties from Springer, is Associate Editor of Hip International and is a Research Committee Member for British Orthopaedic Association. Departmental support for research from DePuy Synthes. None relate to this work. 95 UNDERESTIMATION OF STAPHYLOCOCCUS AUREUS CARRIAGE ASSOCIATED WITH STANDARD CULTURING TECHNIQUES S.-T.J. Tsang1, M. McHugh2, D. Guerendiain2, P. Gwynne3, J. Boyd4, T. Walsh5, I. Laurenson2, K. Templeton2, H. Simpson1 1University of Edinburgh, Department of Orthopaedic Surgery, Edinburgh, United Kingdom, 2Royal Infirmary of Edinburgh, Department of Clinical Microbiology, Edinburgh, United Kingdom, 3University of Edinburgh, School of Biological Sciences, Edinburgh, United Kingdom, 4University of Edinburgh, Edinburgh Clinical Trials Unit, Edinburgh, United Kingdom, 5University of Edinburgh, Department of Anaesthesia, Critical Care and Pain Medicine, Edinburgh, United Kingdom Background: Nasal carriers of Staphylococcus aureus (MRSA and MSSA) have an increased risk for health-care associated infections. There are currently limited screening policies for the detection of S. aureus in the US and UK despite WHO recommendations. This study aimed to; evaluate the diagnostic performance of molecular and culture techniques in S.
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