Revision total hip arthroplasty is associated with poorer clinically meaningful improvements and patient satisfaction compared to primary total hip arthroplasty

2021 ◽  
Author(s):  
Siyuan Zhang ◽  
Jerry Yongqiang Chen ◽  
Hee Nee Pang ◽  
Ngai Nung Lo ◽  
Seng Jin Yeo ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Revision Total Hip Arthroplasty ◽  
Total Hip ◽  
Primary Total Hip Arthroplasty

Should National Standards for Reporting Surgical Site Infections Distinguish between Primary and Revision Orthopedic Surgeries?

2010 ◽  
Vol 31 (05) ◽  
pp. 503-508 ◽  
Author(s):  
Surbhi Leekha ◽  
Priya Sampathkumar ◽  
Daniel J. Berry ◽  
Rodney L. Thompson
Keyword(s):  
Total Hip Arthroplasty ◽  
Confidence Interval ◽  
Hip Arthroplasty ◽  
Odds Ratio ◽  
Risk Index ◽  
National Standards ◽  
Revision Total Hip Arthroplasty ◽  
Total Hip ◽  
Hip Arthroplasties ◽  
Primary Total Hip Arthroplasty

Objective. To compare the surgical site infection (SSI) rate after primary total hip arthroplasty with the SSI rate after revision total hip arthroplasty. Design. Retrospective cohort study. Setting. Mayo Clinic in Rochester, Minnesota, a referral orthopedic center. Patients. All patients undergoing primary total hip arthroplasty or revision total hip arthroplasty during the period from January 1, 2002, through December 31, 2006. Methods. We obtained data on total hip arthroplasties from a prospectively maintained institutional surgical database. We reviewed data on SSIs collected prospectively as part of routine infection control surveillance, using the criteria of the Centers for Disease Control and Prevention for the definition of an SSI. We used logistic regression analyses to evaluate differences between the SSI rate after primary total hip arthroplasty and the SSI rate after revision total hip arthroplasty. Results. A total of 5,696 total hip arthroplasties (with type 1 wound classification) were analyzed, of which 1,381 (24%) were revisions. A total of 61 SSIs occurred, resulting in an overall SSI rate of 1.1% for all total hip arthroplasties. When stratified by the National Nosocomial Infection Surveillance (NNIS) risk index, SSI rates were 0.5%, 1.2%, and 1.6% in risk categories 0, 1, and 2, respectively. After controlling for the NNIS risk index, the risk of SSI after revision total hip arthroplasty was twice as high as that after primary total hip arthroplasty (odds ratio, 2.2 [95% confidence interval, 1.3-3.7]). In the analysis restricted to the development of deep incisional or organ space infections, the risk of SSI after revision total hip arthroplasty was nearly 4 times that after primary total hip arthroplasty (odds ratio, 3.9 [95% confidence interval, 2.0-7.6]). Conclusion. Including revision surgeries in the calculation of SSI rates can result in higher infection rates for institutions that perform a larger number of revisions. Taking NNIS risk indices into account does not eliminate this effect. Differences between primary and revision surgeries should be considered in national standards for the reporting of SSIs.

The effect of precautions on early dislocations post total hip arthroplasty: a retrospective cohort study

2018 ◽  
Vol 28 (5) ◽  
pp. 485-490 ◽  
Author(s):  
Felix C Allen ◽  
Daniel L Skinner ◽  
Jane Harrison ◽  
Giles H Stafford
Keyword(s):  
Patient Satisfaction ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Recent Literature ◽  
Dislocation Rate ◽  
Electronic Database ◽  
Total Hip ◽  
Oxford Hip Score ◽  
Hip Precautions ◽  
Primary Total Hip Arthroplasty

Introduction: The efficacy of hip precautions in preventing dislocation post total hip arthroplasty (THA) has been questioned in recent literature. From 2014 our centre ceased routinely prescribing them due to lack of evidence. We investigate the effect of stopping these precautions on dislocation rate, patient satisfaction and Oxford hip score (OHS). Methods: Patients who underwent primary total hip arthroplasty prior to this change in protocol ( n = 2551) and for 1 year subsequently ( n = 673) were identified. Operative records were used to identify key demographic and operative data. Incidence of dislocation, OHS and patient satisfaction were extracted from the centre’s electronic database. Subset analysis of those patients dislocating within 6 weeks was performed. Results: Rate of dislocation at 6 weeks in those prescribed and not prescribed precautions was 0.71% and 0.89% respectively ( p = 0.618). At 1 year this rose to 1.25% and 1.49% ( p = 0.406). Satisfaction ( p = 0.332) and OHS ( p = 0.441) at 1 year was not significantly different between cohorts. Conclusions: Cessation of prescribing routine hip precautions post primary THA does not appear to significantly affect overall dislocation rate, patient satisfaction or functional status at 1 year post-operatively.

scholarly journals Revision total hip arthroplasty is associated with significantly higher opioid consumption as compared to primary total hip arthroplasty in the acute postoperative period

2020 ◽  
Vol 30 (1_suppl) ◽  
pp. 59-63
Author(s):  
Jenna A Bernstein ◽  
James Feng ◽  
Siddharth A Mahure ◽  
Ran Schwarzkopf ◽  
William J Long
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Opioid Consumption ◽  
Revision Total Hip Arthroplasty ◽  
Opioid Use ◽  
Visual Analogue Pain ◽  
Total Hip ◽  
Revision Tha ◽  
Vas Scores ◽  
Primary Total Hip Arthroplasty

Background: There are currently a lack of investigations that characterised narcotic utilisation following revision total hip arthroplasty (THA). We sought to determine if immediate post-surgical opioid use was different between revision THA and primary THA. Methods: A single institution total joint arthroplasty database was used to identify adult patients who underwent revision THA or primary THA from 2016 to 2019. Morphine milligram equivalents (MME) were calculated for different time periods. Results: 6977 patients were identified, 89.72% primary THA and 10.28% revision THA. Aggregate opioid consumption was higher for revision THA patients (317.40 MME vs. 93.01 MME), as was opioid consumption in the first 24 hour and second 24-hour periods. Visual analogue pain (VAS) scores were significantly higher in the 0–12 hour postoperative and the 12–24 hours postoperative periods in the revision THA group. Conclusions: Patients undergoing revision THA had significantly higher narcotic utilisation than those undergoing primary THA, particularly in the first 24 hours postoperatively.

scholarly journals Analgesic effect of single-shot ropivacaine at different layers of the surgical site in primary total hip arthroplasty: a randomised, controlled, observer-blinded study

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Qiang Xiao ◽  
Bing Xu ◽  
Haoyang Wang ◽  
Zhenyu Luo ◽  
Mingcheng Yuan ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Single Shot ◽  
Superficial Fascia ◽  
Total Hip ◽  
Vas Scores ◽  
Secondary Outcomes ◽  
Group B ◽  
Primary Total Hip Arthroplasty

Abstract Objectives The aim of this study was to evaluate the efficacy of local infiltration anaesthesia (LIA) during primary total hip arthroplasty (THA) via a posterolateral approach under general anaesthesia and to compare the efficacy of LIA in all layers with LIA in the deep and superficial fascia. Patients and methods One hundred twenty patients were randomised into three groups: LIA in the deep and superficial fascia (group A), LIA in all layers (group B) and the control (group C). The primary outcomes were the visual analogue scale (VAS) pain scores at rest and on movement within 72 h (h) postoperatively. The secondary outcomes included opioid consumption, patient satisfaction, range of motion (ROM), straight leg raise completion rate, length of hospital stay, opioid-related side effects and wound complications. We followed the patients until 6 months after discharge. Results At 2 and 6 h, groups A and B had lower resting VAS scores than group C (p < 0.01); at 12 h, group B had a lower resting VAS score than group C (p < 0.05). At 6 and 12 h, the movement VAS scores in groups A and B were lower than those in group C (p < 0.01). Groups A and B had similar VAS scores during the observation period. Groups A and B had higher levels of patient satisfaction than group C (p = 0.03 and p = 0.018, respectively). Opioid consumption was similar in the three groups. There were no significant differences in the other secondary outcomes amongst the three groups. No difference was found in hip rehabilitation or chronic pain during the follow-up period. Conclusion Single-shot LIA with ropivacaine alone reduces the pain score during the first 12 postoperative hours and improves patients’ satisfaction with THA. LIA in the deep and superficial fascia and LIA in all layers have similar analgesic effects. LIA in the deep and superficial fascia may be an alternative method to LIA in all layers.

scholarly journals Femoral Head and Liner Exchange in Patients with Atraumatic Dislocation. Results of a Retrospective Study with 6 Years Follow-Up

Medicina ◽  
2021 ◽  
Vol 57 (11) ◽  
pp. 1188
Author(s):  
Maximilian G. Hanslmeier ◽  
Michael W. Maier ◽  
Manuel Feisst ◽  
Nicholas A. Beckmann
Keyword(s):  
Femoral Head ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Polyethylene Wear ◽  
Revision Arthroplasty ◽  
Revision Total Hip Arthroplasty ◽  
Total Hip ◽  
Total Arthroplasty ◽  
Primary Total Hip Arthroplasty

Background and Objectives: Femoral head and liner exchange is an established treatment for polyethylene wear but has had a more limited role in the treatment of other conditions including dislocation, because of concerns about an increased postoperative dislocation rate. Some authors have considered dislocation associated with polyethylene wear to be a contraindication for this procedure. Materials and Methods: Our retrospective review evaluated the outcome of head and liner exchange in a small consecutively operated heterogeneous cohort of 20 patients who presented with dislocation unrelated to trauma, component malposition or component loosening. Of this group, 12 had prior primary total hip arthroplasty, and 8 had prior revision total hip arthroplasty, and included 4 patients with prior revision for dislocation. Mean follow-up was 6 ± 3.5 years (range 1–145 months). Results: Kaplan–Meier analysis revealed a revision-free implant survival from any cause of 80% (confidence interval 95%:64.3–99.6%) at 5 years after head and liner exchange (index surgery). At final follow-up, 83.3% of patients (n = 10) with prior primary total hip arthroplasty and 62.5% of patients (n = 5) with prior revision total hip arthroplasty, had not required subsequent revision for any cause. None (0%) of the primary total hip arthroplasty group and 3 (38%) of the revision arthroplasty group had required revision for further dislocation. Of the eight revision arthroplasty patients, four had a prior revision for dislocation and three of these four patients required further revision for dislocation after index surgery. The fourth patient had no dislocation after index surgery. One additional patient who had prior revision surgery for femoral component fracture suffered dislocation after index surgery, but was successfully treated with closed reduction. Conclusions: In our study population, femoral head and liner exchange was an effective treatment option for patients with prior primary total hip arthroplasty and also for a highly select group of revision total arthroplasty patients with no prior history of dislocation. Femoral head and liner exchange does not appear to be a viable treatment option for patients who have had revision total arthroplasty after prior dislocations.

A Comparative Analysis of Patient Satisfaction following Total Knee Arthroplasty and Total Hip Arthroplasty Using the Forgotten Joint Score

2020 ◽  
Vol 04 (02) ◽  
pp. 084-089
Author(s):  
Vivek Singh ◽  
Stephen Zak ◽  
Ran Schwarzkopf ◽  
Roy Davidovitch
Keyword(s):  
Total Knee Arthroplasty ◽  
Patient Satisfaction ◽  
Total Hip Arthroplasty ◽  
Knee Arthroplasty ◽  
Hip Arthroplasty ◽  
Demographic Data ◽  
Demographic Differences ◽  
Total Hip ◽  
Forgotten Joint Score ◽  
Total Knee

AbstractMeasuring patient satisfaction and surgical outcomes following total joint arthroplasty remains controversial with most tools failing to account for both surgeon and patient satisfaction in regard to outcomes. The purpose of this study was to use “The Forgotten Joint Score” questionnaire to assess clinical outcomes comparing patients who underwent a total hip arthroplasty (THA) with those who underwent a total knee arthroplasty (TKA). We conducted a retrospective review of patients who underwent primary THA or TKA between September 2016 and September 2019 and responded to the Forgotten Joint Score-12 (FJS-12) questionnaire at least at one of three time periods (3, 12, and 21 months), postoperatively. An electronic patient rehabilitation application was used to administer the questionnaire. Collected variables included demographic data (age, gender, race, body mass index [BMI], and smoking status), length of stay (LOS), and FJS-12 scores. t-test and chi-square were used to determine significance. Linear regression was used to account for demographic differences. A p-value of less than 0.05 was considered statistically significant. Of the 2,359 patients included in this study, 1,469 underwent a THA and 890 underwent a TKA. Demographic differences were observed between the two groups with the TKA group being older, with higher BMI, higher American Society of Anesthesiologists scores, and longer LOS. Accounting for the differences in demographic data, THA patients consistently had higher scores at 3 months (53.72 vs. 24.96; p < 0.001), 12 months (66.00 vs. 43.57; p < 0.001), and 21 months (73.45 vs. 47.22; p < 0.001). FJS-12 scores for patients that underwent THA were significantly higher in comparison to TKA patients at 3, 12, and 21 months postoperatively. Increasing patient age led to a marginal increase in FJS-12 score in both cohorts. With higher FJS-12 scores, patients who underwent THA may experience a more positive evolution with their surgery postoperatively than those who had TKA.

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