A Call to Action: A High Prevalence of Mental Health Conditions in Septic Compared with Aseptic Revision Total Hip Arthroplasty

2020 ◽  
Vol 04 (02) ◽  
pp. 077-083
Author(s):  
Jared Warren ◽  
Hiba K. Anis ◽  
Alison K. Klika ◽  
Suparna Navale ◽  
Guangjin Zhou ◽  
...  
Keyword(s):  
Mental Health ◽  
Bipolar Disorder ◽  
Drug Abuse ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Health Conditions ◽  
Revision Total Hip Arthroplasty ◽  
Mental Health Conditions ◽  
Total Hip ◽  
Aseptic Revision

AbstractProsthetic joint infections (PJIs) after primary total hip arthroplasty (pTHA) are known to have a profound impact on patients' pain and function. However, there is little evidence on the association between PJIs and mental health in pTHA and revision total hip arthroplasty (rTHA) patients. The purpose of this study was to compare the prevalence of mental health conditions among patients undergoing (1) pTHA, (2) septic rTHA, and (3) aseptic rTHA. All THAs performed between 2005 and 2014 were queried using the Healthcare Cost and Utilization Project State Inpatient Databases. This yielded 468,663 patients. Patients were separated into the following cohorts based on procedure: primary, septic revision, and aseptic revision. Diagnoses of any mental health condition as well as the following specific conditions were compared among the three cohorts: schizophrenia/delusion, bipolar disorder, depression/mood disorder, personality disorder, anxiety/somatic/dissociative disorder, eating disorders, attention-deficit/hyperactivity disorder/conduct/impulse control, alcohol abuse, and drug abuse. Univariate analysis was performed to assess differences and trends in mental health conditions among the three cohorts. The prevalence of mental health conditions overall in rTHA patients increased throughout the study period. There was a significantly higher prevalence of mental health conditions overall among patients in the septic rTHA cohort (n = 1,818, 28.0%) compared with the pTHA (n = 81,616, 19.2%; p < 0.001), and aseptic rTHA (n = 7,594, 20.9%; p < 0.001) cohorts. Specifically, septic rTHA patients had a higher prevalence of schizophrenia (p < 0.001; p < 0.001), bipolar disorder (p < 0.001; p < 0.001), depression (p < 0.001; p < 0.001), personality disorders (p = 0.0015; p = 0.013), anxiety (p < 0.001; p = 0.0055), eating disorders (p < 0.001; p = 0.006), alcohol abuse (p < 0.001; p < 0.001), and drug abuse (p < 0.001; p < 0.001) compared with primary THA and aseptic rTHA, respectively. Overall, rates of mental health conditions were significantly higher among septic rTHA patients. Alcohol and drug abuse were approximately twice as prevalent among patients undergoing rTHA for infection compared with primary or aseptic rTHA patients. The level of evidence of the study is level III.

Morbidly Obese vs Nonobese Aseptic Revision Total Hip Arthroplasty: Surprisingly Similar Outcomes

2016 ◽  
Vol 31 (4) ◽  
pp. 842-845 ◽  
Author(s):  
Chad D. Watts ◽  
Matthew T. Houdek ◽  
Eric R. Wagner ◽  
David G. Lewallen ◽  
Tad M. Mabry
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Morbidly Obese ◽  
Revision Total Hip Arthroplasty ◽  
Total Hip ◽  
Aseptic Revision

scholarly journals REDUCED INFECTION RATE AFTER ASEPTIC REVISION TOTAL HIP ARTHROPLASTY WITH EXTENDED ORAL ANTIBIOTIC PROTOCOL

2018 ◽  
Vol 1 (1) ◽  
Author(s):  
Amer Mohiuddin, BS ◽  
Justin Rice, BA ◽  
Mary Ziemba-Davis, BA ◽  
R. Michael Meneghini, MD
Keyword(s):  
Total Hip Arthroplasty ◽  
Infection Rate ◽  
Hip Arthroplasty ◽  
Joint Infection ◽  
Deep Infection ◽  
Oral Antibiotic ◽  
Revision Total Hip Arthroplasty ◽  
Total Hip ◽  
Aseptic Revision ◽  
One Year

Background and Hypothesis: Periprosthetic joint infection (PJI is a leading cause of failure after aseptic revision total hip arthroplasty (RTHA). While well documented in the primary setting, perioperative antibiotic duration is not well described in RTHA where the risk of PJI was recently reported to be 8% one-year post-revision. The study purpose was to evaluate whether extended oral antibiotic prophylactic protocol minimizes PJI in aseptic RTHA patients compared to the published literature.   Project Methods: 169 consecutive aseptic RTHAs performed with modern perioperative and infection-prevention protocols by a single surgeon at a single center were retrospectively reviewed. 80% of patients were discharged on 7-day oral antibiotic prophylaxis while intra-operative cultures were incubating. Infections and reoperations were documented.   Results: Average age and BMI were 63 years and 30 kg/m2.  67% percent of patients were ASA-III/IV, signifying the severity of comorbidities in this revision cohort. There we no cases of PJI in the 90-day postoperative period. Ninety-eight percent of cases were infection free at mean follow-up of 45 months. Three (1.8%) cases underwent reoperation for deep infection at 110, 161 and 581 days.    Conclusion and Potential Impact: Our observed infection rate of 0.0% is lower than published infection rates following RTHA and a 1.5% infection rate in primary THA in patients with no identifiable risk factors for PJI.  Based on this clinically meaningful decrease in PJI in this challenging cohort, we encourage further study regarding extended antibiotic protocol weighed appropriately against potential consequences.   

Aseptic revision total hip arthroplasty in the elderly

2018 ◽  
Vol 100-B (2) ◽  
pp. 143-151 ◽  
Author(s):  
P. Bovonratwet ◽  
R. Malpani ◽  
T. D. Ottesen ◽  
V. Tyagi ◽  
N. T. Ondeck ◽  
...  
Keyword(s):  
Risk Factors ◽  
Adverse Event ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
National Database ◽  
Revision Total Hip Arthroplasty ◽  
Serious Adverse Event ◽  
Total Hip ◽  
Revision Tha ◽  
Aseptic Revision

AimsThe aim of this study was to compare the rate of perioperative complications following aseptic revision total hip arthroplasty (THA) in patients aged ≥ 80 years with that in those aged < 80 years, and to identify risk factors for the incidence of serious adverse events in those aged ≥ 80 years using a large validated national database.Patients and MethodsPatients who underwent aseptic revision THA were identified in the 2005 to 2015 National Surgical Quality Improvement Program (NSQIP) database and stratified into two age groups: those aged < 80 years and those aged ≥ 80 years. Preoperative and procedural characteristics were compared. Multivariate regression analysis was used to compare the risk of postoperative complications and readmission. Risk factors for the development of a serious adverse event in those aged ≥ 80 years were characterized.ResultsThe study included 7569 patients aged < 80 years and 1419 were aged ≥ 80 years. Multivariate analysis showed a higher risk of perioperative mortality, pneumonia, urinary tract infection and the requirement for a blood transfusion and an extended length of stay in those aged ≥ 80 years compared with those aged < 80 years. Independent risk factors for the development of a serious adverse event in those aged ≥ 80 years include an American Society of Anesthesiologists score of ≥ 3 and procedures performed under general anaesthesia.ConclusionEven after controlling for patient and procedural characteristics, aseptic revision THA is associated with greater risks in patients aged ≥ 80 years compared with younger patients. This is important for counselling and highlights the need for medical optimization in these vulnerable patients. Cite this article: Bone Joint J 2018;100-B:143–51.

Thirty-Day Readmissions After Aseptic Revision Total Hip Arthroplasty: Rates, Predictors, and Reasons Vary by Surgical Indication

2020 ◽  
Vol 35 (12) ◽  
pp. 3673-3678
Author(s):  
Neil Pathak ◽  
Cynthia A. Kahlenberg ◽  
Harold G. Moore ◽  
Peter K. Sculco ◽  
Jonathan N. Grauer
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Surgical Indication ◽  
Revision Total Hip Arthroplasty ◽  
Total Hip ◽  
Aseptic Revision

Modular Fluted Tapered Stems in Aseptic Revision Total Hip Arthroplasty

2017 ◽  
Vol 99 (10) ◽  
pp. 873-881 ◽  
Author(s):  
Matthew P. Abdel ◽  
Umberto Cottino ◽  
Dirk R. Larson ◽  
Arlen D. Hanssen ◽  
David G. Lewallen ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Revision Total Hip Arthroplasty ◽  
Total Hip ◽  
Aseptic Revision

scholarly journals Trochanteric osteotomy in revision total hip arthroplasty

2020 ◽  
Vol 5 (8) ◽  
pp. 477-485
Author(s):  
Kavin Sundaram ◽  
Ahmed Siddiqi ◽  
Atul F. Kamath ◽  
Carlos A. Higuera-Rueda
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Vastus Lateralis ◽  
Revision Total Hip Arthroplasty ◽  
Trochanteric Osteotomy ◽  
Transfemoral Approach ◽  
Total Hip ◽  
Aseptic Revision ◽  
Extensile Approach ◽  
Trochanteric Slide

Trochanteric osteotomy is a technique that allows expanded exposure and access to the femoral canal and acetabulum for a number of indications. There has been renewed interest in variants of this technique, including the trochanteric slide osteotomy (TSO), extended trochanter osteotomy (ETO), and the transfemoral approach, for both septic and aseptic revision total hip arthroplasty (THA). Osteotomy fixation is crucial for achieving union, and wire and cable-plate systems are the most common techniques. TSO involves the creation of a greater trochanter fragment with preserved abductor attachment proximally and vastus lateralis attachment distally. This technique may be particularly useful in the setting of abductor deficiency or when augmented acetabular exposure is needed. ETO is a posterior-laterally based extensile approach that has been successfully utilized for aseptic and septic indications; most series report a greater than 90% rate of union. The transfemoral approach, as known as the Wagner osteotomy, is an extensile femoral approach and is more anterior-based than the alternate posterior-based ETO. It may be particularly useful for anterior-based approaches and anterior femoral remodelling; rates of union after this approach in most reports have been close to 100%. Cite this article: EFORT Open Rev 2020;5:477-485. DOI: 10.1302/2058-5241.5.190063

Etiology and Complications of Early Aseptic Revision Total Hip Arthroplasty Within 90 Days

2020 ◽  
Author(s):  
Tony S. Shen ◽  
Alex Gu ◽  
Patawut Bovonratwet ◽  
Nathaniel T. Ondeck ◽  
Peter K. Sculco ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Revision Total Hip Arthroplasty ◽  
Total Hip ◽  
Aseptic Revision
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