Short-Term Outcomes of Total Hip Arthroplasty After Complications of Open Reduction Internal Fixation for Hip Fracture

Objective To examine sonication results in presumed aseptic conversion total hip arthroplasty (THA) after hip fracture fixation and to evaluate its implications on the treatment outcome. Methods This retrospective cohort study reviewed the data from presumed aseptic patients that underwent conversion of prior internal fixation of proximal femoral fractures to THA between 2012 and 2018. Microbiological analysis was performed using sonication of osteosynthesis material and tissue samples. Treatment outcome including the occurrence of periprosthetic joint infection (PJI) was recorded. Results A total of 32 patients were included in the study. Of these, five patients (15.6%) had positive intraoperative cultures. The mean follow-up following conversion THA was 43.0 months (range, 19.0–91.5 months). Sonication was positive in three patients (9.4%), all of whom were deemed contaminated and did not develop PJI. Tissue cultures were positive in two patients (6.3%). One patient with Enterococcus faecalis received antibiotic treatment and did not develop PJI. Another patient with growth of Cutibacterium acnes that was initially classified as a contaminant later developed acute PJI caused by the same pathogen. Overall, PJI occurred in two patients (6.3%) after conversion THA. Conclusion Sonication of internal fixation devices did not add diagnostic value in clinically aseptic conversion THA. Further studies are needed to better understand the relevance of unexpected positive cultures, and to develop diagnostic criteria for the management of these patients.

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Open Reduction and Internal Fixation Versus Total Hip Arthroplasty for the Treatment of Acute Displaced Acetabular Fractures

The Journal of Bone and Joint Surgery (American) ◽

10.2106/00004623-200211000-00033 ◽

2002 ◽

Vol 84 (11) ◽

pp. 2103-2104 ◽

Cited By ~ 8

Author(s):

Paul E. Beaulé

Keyword(s):

Total Hip Arthroplasty ◽

Internal Fixation ◽

Hip Arthroplasty ◽

Open Reduction ◽

Acetabular Fractures ◽

Total Hip

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Total Hip Arthroplasty Outperforms Hemiarthroplasty in Patients Aged 65 Years and Older: A Propensity-Matched Study of Short-Term Outcomes

Geriatric Orthopaedic Surgery & Rehabilitation ◽

10.1177/2151459319876854 ◽

2019 ◽

Vol 10 ◽

pp. 215145931987685 ◽

Cited By ~ 1

Author(s):

Jared A. Warren ◽

Kavin Sundaram ◽

Hiba K. Anis ◽

Nicolas S. Piuzzi ◽

Carlos A. Higuera ◽

...

Keyword(s):

Hip Fracture ◽

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Short Term ◽

Improvement Project ◽

Treatment Pathways ◽

Total Hip ◽

Displaced Femoral Neck Fractures ◽

Increased Risk ◽

Payment Models

Introduction: Displaced femoral neck fractures in the elderly individuals may be treated with total hip arthroplasty (THA) or hip hemiarthroplasty (HHA). However, it is unclear what the short-term medical outcomes are related to these surgical options. The purpose of this study was to compare early postoperative outcomes in THA patients to those of HHA patients. Methods: In this study, we compared 30-day mortality, likelihood of still being in the hospital at 30 days, postoperative major and minor complications, discharge disposition, reoperation and readmission, length of stay, days from admission to surgery, and operative time between THA and HHA. Using the American College of Surgeons National Surgical Quality Improvement Project database, hip fracture patients ≥65 years old from 2008 to 2016 were identified. After propensity score matching, there were 2795 THAs and 2795 HHAs. To assess the effect of THA on the above-mentioned outcomes, bivariate regression models were created. Results: The THA patients ≥65 years old were at reduced risk for mortality ( P = .029) and still being in the hospital at 30 days ( P = .017). The THA patients were at an increased risk for minor complications ( P = .011) and longer operative times ( P < .001). However, THA patients were more likely to have a home discharge ( P < .001). Discussion: Patients ≥65 years who underwent THA for hip fractures had reduced short-term mortality risk, were more likely to be discharged home, and had less likelihood of being in the hospital at 30 days. This is the first study to explore short-term outcomes in patients ≥65 and has direct implications for alternate payment and merit-based payment models. Conclusion: As hip fracture treatment has come under scrutiny with respect to alternate payment models and merit-based incentive payments, this analysis of short-term outcomes warrants consideration when evaluating treatment pathways.

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