scholarly journals Population pharmacokinetic model of cefazolin in total hip arthroplasty

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
J. Lanoiselée ◽  
R. Chaux ◽  
S. Hodin ◽  
S. Bourayou ◽  
A. Gibert ◽  
...  
Keyword(s):  
Renal Function ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Population Analysis ◽  
Total Body Weight ◽  
Compartment Model ◽  
Population Pharmacokinetic ◽  
Total Hip ◽  
Concentration Threshold ◽  
Elimination Clearance

AbstractCefazolin is an antibiotic recommended for infection prevention in total hip arthroplasty (THA). However, the dosing regimen necessary to achieve therapeutic concentrations in obese patients remains unclear. The aim of this study was to conduct a population analysis of cefazolin pharmacokinetics (PK) and assess whether cefazolin administration should be weight adapted in THA. Adult patients undergoing THA surgery received an injection of 2000 mg of cefazolin, doubled in the case of BMI > 35 kg/m2 and total body weight > 100 kg. A population PK study was conducted to quantify cefazolin exposure over time compared to the therapeutic concentration threshold. A total of 484 cefazolin measurements were acquired in 100 patients, of whom 29% were obese. A 2-compartment model best fitted the data, and creatinine clearance determined interpatient variability in elimination clearance. Our PK simulations using a 2000 mg cefazolin bolus showed that cefazolin concentrations remained above the threshold throughout surgery, regardless of weight or renal function. A 2000 mg cefazolin single injection without adaptation to weight or renal function and without intraoperative reinjection was efficient in maintaining therapeutic concentrations throughout surgery. The optimal target concentration and necessary duration of its maintenance remain unclear.

scholarly journals Prevalence of Anterior Femoral Neck Osteophyte in a Total Hip Arthroplasty Population: Analysis of Preoperative Surgical Plans

2019 ◽  
Vol 2019 ◽  
pp. 1-5
Author(s):  
Adam M. Katchky ◽  
Mitchell L. Smith ◽  
Andrew J. Shimmin ◽  
Stephen J. McMahon ◽  
Jeremy Latham ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Femoral Neck ◽  
Hip Arthroplasty ◽  
Preoperative Planning ◽  
Population Analysis ◽  
Joint Stability ◽  
Rater Reliability ◽  
Total Hip ◽  
Implant Positioning ◽  
Number Of Patients

Despite strongly positive results of total hip arthroplasty (THA), patients remain at risk for complications including dislocation. Spinopelvic motion and the hip-spine relationship have been recognized as important factors in surgical planning and implant positioning in THA. Periarticular osteophytes are one of the hallmark pathoanatomic features of osteoarthritis and may influence implant positioning and joint stability; residual osteophytes at the anterior femoral neck may cause anterior impingement and posterior instability. No studies have been identified which establish the prevalence of anterior femoral neck osteophyte for incorporation into THA planning. 413 consecutive patients scheduled for THA underwent preoperative planning taking into account spinopelvic motion to establish optimal component position. Each surgical plan was reviewed retrospectively by four independent raters who were blinded to other imaging and intraoperative findings. Anterior femoral neck osteophytes were rated as being absent, minor, or extensive for each case. A single outlying rater was excluded. Inter-rater reliability was calculated manually. The patient group comprised 197 male and 216 female hips, with a mean age of 63 years (range 32–91). The presence of anterior femoral neck osteophytes was identified in a mean of 82% of cases (range 78–86%). A significant number of patients were found to have large or extensive osteophytes present in this location (mean 27%; range 23–31%). Inter-rater reliability was 70%. A large majority of our THA patients were found to have anterior femoral neck osteophytes. These must be considered during preoperative planning with respect to the spinopelvic relationship. Failure to identify and address osteophytes intraoperatively may increase the risk of impingement in flexion and/or internal rotation, leading to decreased range of motion, joint instability, and possibly dislocation. Planned future directions include incorporation of an impingement and instability model into preoperative planning for THA.

Use of Total Hip Arthroplasty in Patients Under 21 Years Old: A U.S. Population Analysis

2021 ◽  
Author(s):  
Cynthia A. Kahlenberg ◽  
J. Alex Gibbons ◽  
Deanna Jannat-Khah ◽  
Susan M. Goodman ◽  
Lisa A. Mandl ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Population Analysis ◽  
Total Hip

scholarly journals Population Pharmacokinetic and Pharmacodynamic Target Attainment Analysis of Cefazolin in the Serum and Hip Joint Capsule of Patients Undergoing Total Hip Arthroplasty

2021 ◽  
Author(s):  
Toshiaki Komatsu ◽  
Yui Natsume ◽  
Katsufumi Uchiyama ◽  
Shinsuke Ikeda ◽  
Yoshinori Tomoda ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Population Pharmacokinetics ◽  
Hip Joint ◽  
Hip Arthroplasty ◽  
Joint Capsule ◽  
Pharmacokinetic Parameters ◽  
Population Pharmacokinetic ◽  
Serum Samples ◽  
Nonlinear Mixed Effects Model ◽  
Total Hip

The objectives of this study were to evaluate the population pharmacokinetics of prophylactic cefazolin (CFZ) from its serum and hip joint capsule concentrations in patients undergoing total hip arthroplasty, and to establish pharmacodynamic target concentration exceeding the MIC for designing an effective dosing regimen for serum and the hip joint capsule. We analyzed 249 serum samples and 125 hip joint capsule samples from 125 individuals using a nonlinear mixed-effects model. The pharmacodynamic index target value obtained from our results indicates the probability of maintaining CFZ trough and hip joint capsule concentrations exceeding the MIC of 1 mg/L, to account for methicillin-susceptible S. aureus (MSSA). We estimated the population pharmacokinetics using a two-compartment model. The estimated population pharmacokinetic parameters were as follows: CL (L/h) = 1.46 × (CLcr (mL/min)/77)0.891, Vc (L) = 7.5, Q (L/h) = 3.38, and VJC (L) = 36.1. The probability of achieving concentrations exceeding the MIC90 for MSSA was approximately 100% for serum and 100% for the hip joint capsule at 3 h after the initial dose. Our findings suggest that population-based parameters are useful for evaluating CFZ pharmacokinetics and that individual dosages should be determined based on the dosage regimen that achieves and maintains adequate tissue CFZ concentration.

MR Imaging with Metal Artifact Reduction to Differentiate between Patients with and without Infected Total Hip Arthroplasty

2018 ◽  
Author(s):  
Benedikt Schwaiger ◽  
Alexandra Gersing ◽  
Daniela Muenzel ◽  
Julia Dangelmaier ◽  
Peter Prodinger ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Mr Imaging ◽  
Hip Arthroplasty ◽  
Artifact Reduction ◽  
Metal Artifact ◽  
Metal Artifact Reduction ◽  
Total Hip

Plasma Prekallikrein Activity in Patients with Total Hip Arthroplasty

1987 ◽  
Vol 58 (04) ◽  
pp. 1040-1042
Author(s):  
J J M L Hoffmann ◽  
J H J P M Kortmann
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Hip Prosthesis ◽  
Contact System ◽  
Factor Xii ◽  
Total Hip ◽  
Activity Factor ◽  
Patient Groups ◽  
Kallikrein Activity

SummaryThe behaviour of the contact system was studied in 40 patients with total hip arthroplasty, by measuring plasma prekallikrein, spontaneous kallikrein activity and factor XII. In the literature it had been shown that patients with complications from this operation had decreased prekallikrein and increased kallikrein activity (M. Nakahara. Acta orthop scand 1982; 53: 591-6). In the present study, comprising patients with and without pain and proven loosening of the hip prosthesis, these findings could only partially be confirmed. Patients with a loosened prosthesis had significantly lower prekallikrein (mean 0.78 ± 0.28 U/ml; p <0.01) than patients without problems, but no detectable kallikrein activity in plasma. Patients with pain but no loosening had normal prekallikrein (1.04 ±0 0.26 U/ml) and also no demonstrable kallikrein activity. Factor XII was normal in all patient groups. It is concluded that decreased prekallikrein is limited to patients with a loosened hip prosthesis, with or without pain.

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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