Rakshith P. Uttam

Background: Hospital-acquired COVID-19 presents a distinct challenge in orthopaedic care within low- and middle-income country (LMIC) settings, where prolonged isolation, delayed mobilization and system constraints increase immobilization-related morbidity. Unlike high-income settings that emphasize respiratory outcomes, LMIC orthopaedic inpatients appear to face a disproportionate burden of thromboembolic complications, particularly deep vein thrombosis (DVT). Methods: A retrospective cohort study was conducted at a South Indian teaching hospital between January 2020 and December 2025. Orthopaedic inpatients with RT-PCR–confirmed COVID-19 were categorized as having nosocomial or community-acquired infection based on timing of diagnosis. Demographic data, injury and treatment characteristics, immobilization duration, comorbidity burden, thromboprophylaxis use and vitamin D status were analysed. DVT was diagnosed using duplex ultrasonography and multivariable logistic regression identified independent predictors. Results: Of 217 patients (median age 48 years; 68.2% male), 68 developed nosocomial COVID-19. Hospital-acquired infection was associated with significantly longer hospital stay and immobilization. Overall DVT incidence was 11.1%, with a higher prevalence in nosocomial compared with community-acquired cases (19.1% vs. 7.4%). Nosocomial infection, immobilization exceeding seven days and vitamin D deficiency independently predicted DVT. In-hospital mortality did not differ between groups. Conclusion: Hospital-acquired COVID-19 significantly increases DVT risk among orthopaedic inpatients in LMIC settings, driven primarily by prolonged immobilization. Preventive strategies should prioritize early mobilization, optimized isolation workflows and correction of modifiable risk factors to reduce avoidable thromboembolic morbidity.

Total hip and knee arthroplasty volumes are increasing worldwide and neuraxial anaesthesia is often preferred over general anaesthesia because of perceived perioperative benefits. However, much of the available evidence is derived from observational studies and may be influenced by selection bias and confounding by indication. This narrative review synthesised contemporary literature from PubMed and Google scholar up to December 2025, focusing on large cohort, registry and administrative database studies comparing the two techniques in primary THA and TKA. Across multiple datasets, neuraxial anaesthesia was associated with lower mortality, fewer complications, reduced transfusion requirements and shorter hospital stay. However, patients receiving general anaesthesia consistently had higher baseline risk profiles, including older age, higher ASA status and greater comorbidity burden, along with more frequent contraindications to neuraxial techniques. Although multivariable adjustment and propensity score matching reduced the magnitude of these differences, the overall trends favouring neuraxial anaesthesia persisted. Importantly, residual confounding from unmeasured factors such as frailty, spinal pathology and institutional practices remains a key limitation. Overall, while neuraxial anaesthesia appears to offer favourable perioperative outcomes, the evidence is largely observational and should be interpreted with caution. Anaesthetic choice should be individualised and context-specific, especially in resource-limited settings and future research should focus on randomised trials and risk-stratified decision-making approaches.

Background: Periprosthetic joint infection (PJI) after revision total hip arthroplasty (THA) poses significant wound-management challenges. Outcomes following vacuum-assisted closure (VAC) therapy vary and may be influenced by regional microbiology and host soft-tissue characteristics. Methods: This retrospective comparative cohort study (2019-2025) included adults undergoing revision THA for chronic PJI at a tertiary center. Patients were grouped by geographic origin: India (n=20) and Democratic Republic of Congo (DRC; n=18). Demographics, microbiology, postoperative wound gaping, debridement and VAC sessions, soft-tissue reconstruction, and time to complete wound healing were analysed using non-parametric statistics. Results: The Indian cohort was younger (60.3 vs 67.8 years; p=0.010) but required more debridement’s (3.1 vs 2.3; p=0.031), VAC sessions (2.7 vs 1.6; p=0.003), and flap reconstructions (70% vs 22%). Initial wound gaping occurred at a similar postoperative interval in both cohorts; however, healing time was significantly longer in Indian patients (36.8 vs 18.2 days; p=0.002). Klebsiella predominated in the Indian cohort, whereas Pseudomonas was more common in DRC patients. Conclusions: Geographic differences in wound behaviour following revision THA for PJI suggest that regional microbiology and host soft-tissue factors influence VAC effectiveness and healing outcomes, supporting population-specific wound management strategies.