350. Outcomes for Joint Arthroplasty in Persons Living with HIV

Abstract Background Persons living with HIV (PLHIV) now have dramatically improved life-expectancy with age-related morbidities requiring total joint arthroplasties. We present here an institutional review of PLHIV who underwent total joint arthroplasty and prosthesis-related adverse outcomes at one year. Methods This was a retrospective chart review in a large academic medical center. Inclusion criteria were adult PLHIV undergoing total joint arthroplasty between 2013 and 2017. Arthroplasty-related adverse outcomes within the first-year post-surgery were recorded. Patients were identified using ICD-10 codes and classified as having a PJI using Infectious Diseases Society of America (IDSA) criteria. Results A total of 40 patients met the criteria. The median age was 59 years and 53% of patients were male. The median CD4 count and RNA viral load were 587 (range 94–1920) cells/mm3 and 0 (range 0—189,000) copies/mL, respectively. The most common procedure was hip replacement (55%) and the most common indication for arthroplasty was avascular necrosis (43%). Adverse outcomes including PJI, dislocation, prosthesis loosening, seroma and chronic pain were identified in 28% of patients. PJI occurred in two patients and both required surgical revision. Modifiable risk factors present in both patients were active smoking, history of substance use disorder, chronic pulmonary disease, depression and hepatitis C antibody positivity. Both patients had CD4 counts >600 cells/mm3. Both were on atazanavir containing antiretroviral regimens. Neither patient was screened for MRSA carriage. Causal organisms were MRSA and MSSA respectively and each patient received 6 weeks of antimicrobial therapy. Conclusion This study supports that when medically optimized, PLHIV have favorable outcomes. The two patients who developed PJI had multiple non-HIV modifiable risk factors predisposing them to PJI. In one case, the patient’s isolated organism was MRSA, for which the patient did not receive appropriate pre-operative antimicrobial prophylaxis. This highlights the importance of routine screening for appropriate pre-operative prophylaxis in patients undergoing joint arthroplasty, independent of HIV status. Disclosures All authors: No reported disclosures.

Download Full-text

Smoking Dependent Alterations in Bone Formation and Inflammation Represent Major Risk Factors for Complications Following Total Joint Arthroplasty

Journal of Clinical Medicine ◽

10.3390/jcm8030406 ◽

2019 ◽

Vol 8 (3) ◽

pp. 406 ◽

Cited By ~ 9

Author(s):

Sabrina Ehnert ◽

Romina Aspera-Werz ◽

Christoph Ihle ◽

Markus Trost ◽

Barbara Zirn ◽

...

Keyword(s):

Risk Factors ◽

Clinical Outcome ◽

Bone Formation ◽

Total Joint Arthroplasty ◽

Serum Levels ◽

Joint Arthroplasty ◽

Cigarette Consumption ◽

Post Surgery ◽

Bone Formation Markers ◽

Healing Bone

Numerous studies have described a correlation between smoking and reduced bone mass. This not only increases fracture risk but also impedes reconstruction/fixation of bone. An increased frequency of complications following surgery is common. Here, we investigate the effect of smoking on the clinical outcome following total joint arthroplasty (TJA). 817 patients receiving primary or revision (including clinical transfers) TJA at our level-one trauma center have been randomly interviewed twice (pre- and six months post-surgery). We found that 159 patients developed complications (infections, disturbed healing, revisions, thrombosis, and/or death). Considering nutritional status, alcohol and cigarette consumption as possible risk factors, OR was highest for smoking. Notably, mean age was significantly lower in smokers (59.2 ± 1.0a) than non-smokers (64.6 ± 0.8; p < 0.001). However, the number of comorbidities was comparable between both groups. Compared to non-smokers (17.8 ± 1.9%), the complication rate increases with increasing cigarette consumption (1–20 pack-years (PY): 19.2 ± 2.4% and >20 PY: 30.4 ± 3.6%; p = 0.002). Consequently, mean hospital stay was longer in heavy smokers (18.4 ± 1.0 day) than non-smokers (15.3 ± 0.5 day; p = 0.009) or moderate smokers (15.9 ± 0.6 day). In line with delayed healing, bone formation markers (BAP and CICP) were significantly lower in smokers than non-smokers 2 days following TJA. Although, smoking increased serum levels of MCP-1, OPG, sRANKL, and Osteopontin as well as bone resorption markers (TRAP5b and CTX-I) were unaffected. In line with an increased infection rate, smoking reduced 25OH vitamin D3 (immune-modulatory), IL-1β, IL-6, TNF-α, and IFN-γ serum levels. Our data clearly show that smoking not only affects bone formation after TJA but also suppresses the inflammatory response in these patients. Thus, it is feasible that therapies favoring bone formation and immune responses help improve the clinical outcome in smokers following TJA.

Download Full-text

The Development of a Surgical Readiness Interview Tool for Patients to Improve Conversation on Modifiable Risk Factors Prior to Total Joint Arthroplasty

10.21203/rs.3.rs-48889/v1 ◽

2020 ◽

Author(s):

Kristen I Barton ◽

Christopher E Hewison ◽

Ania Kania-Richmond

Keyword(s):

Risk Factors ◽

Primary Care ◽

Conservative Management ◽

Total Joint Arthroplasty ◽

Qualitative Interviews ◽

Joint Arthroplasty ◽

Care Physician ◽

Qualitative Inquiry ◽

Modifiable Risk Factors ◽

Study Participants

Abstract Background: Total joint arthroplasty (TJA) surgery is conducted forsevere hip and knee osteoarthritis (OA). However, a significant numberof patients referred to orthopedic surgeons with hip and knee OA are not appropriate surgical candidates.Further, many are sent back to their primary care physician because they had not yet exhausted non-surgical options, which suggests the importance surgeons place on exhausting conservative management before proceeding with TJA.The objective of this qualitative inquiry was to 1) explore patients’ perspectives of a surgical readiness interview tool and its potential utility in the management process for patients with OA, and 2) gain input from study participants to further refine the tool and ensure that it is reflective of the patients’ needs and perspectives. Methods: We used a diverse convenience sampling strategy to recruit TJA patients from the hip and knee arthroplasty clinics in Calgary, Alberta. Semi-structured qualitative interviews were conducted using a cognitive interviewing approach in order to elicit information regarding clarity and relevance of the interview tool. All interviews were digitally recorded and transcribed verbatim. Through an iterative process, a coding framework was developed and then applied in the analysis of all interviews. Results: Nine interviews were conducted (n=3 males and n=6), all of whom had a TJA within the previous 12 months. Participants found the questions in the interview tool to be clear and relevant, and nothing listed was unexpected. All participants expressed that they felt comfortable discussing the content of the interview tool with their doctors. The main themes that emerged from the interviews include 1) the need for clarifications, 2) patient-oriented changes, and 3) expectation management. While gaining insight from study participants, the qualitative inquiry confirmed utility of the tool improve the conversation about surgical readiness and utilizing conservative management prior to TJA. Conclusions: Overall, participants were positive about the interview tool and felt that it would lead to better care provision. We recommend the use of the interview tool in primary care settings to support the conversation on modifiable risk factors and non-surgical management strategies for OA prior to TJA.

Download Full-text

Falls and fear of falling in older adults with total joint arthroplasty: a scoping review

BMC Musculoskeletal Disorders ◽

10.1186/s12891-019-2954-9 ◽

2019 ◽

Vol 20 (1) ◽

Cited By ~ 1

Author(s):

Serena Kuangyi Chen ◽

Don Voaklander ◽

Danielle Perry ◽

C. Allyson Jones

Keyword(s):

Risk Factors ◽

Older Adults ◽

Scoping Review ◽

Total Joint Arthroplasty ◽

Fear Of Falling ◽

Joint Arthroplasty ◽

Modifiable Risk Factors ◽

Inclusion Criteria ◽

Increased Risk ◽

Risk Factors For Falls

Abstract Background Patients waiting or recovering from total joint arthroplasty (TJA) are at risk for falls which can lead to restriction of activity and negatively impact recovery. The objective of this scoping review is to critically appraise and synthesize the evidence in the reported number of falls, fear of falling, and risk factors associated with falls in older patients waiting for or recovering from TJA. Methods Seven electronic databases were searched with no date limits and using language restriction (English). The inclusion criteria were 1) cohorts that included older adults 60+ years of age, 2) reported prevalence of falls, fear of falling, and/or risk factors for falls in patients who were waiting or recovering from TJA and 3) cross-sectional studies, cohort studies, and case control study designs. The quality assessment of selected articles was assessed using the SIGN Guidelines Checklist. Results Of the 866 citations identified, 12 studies met the inclusion criteria and were reviewed. Prevalence of falls in pre-operative TJA patients and post-operative TJA patients ranged from 23 to 63%, and 13 to 42%, respectively. Of those five studies that examined fear of falling, pre-operative TJA patients reported greater fear of falling than post-operative patients. Modifiable risk factors for falls included fear of falling, joint range of motion, and depression. Conclusions An increased risk of falls in patients with TJA was reported both for patients waiting for and recovering from surgery. A number of modifiable risk factors were identified including fear of falling that could be targeted in fall prevention programs for TJA.

Download Full-text

Modifiable Risk Factors in Total Joint Arthroplasty

The Journal of Arthroplasty ◽

10.1016/j.arth.2016.06.017 ◽

2016 ◽

Vol 31 (8) ◽

pp. 1619 ◽

Cited By ~ 6

Author(s):

William Jiranek

Keyword(s):

Risk Factors ◽

Total Joint Arthroplasty ◽

Joint Arthroplasty ◽

Modifiable Risk Factors

Download Full-text

Inheritable Risk Factors for Venous Thromboembolism in Patients Undergoing Lower Extremity Total Joint Arthroplasty

Journal of Long-Term Effects of Medical Implants ◽

10.1615/jlongtermeffmedimplants.2013010092 ◽

2013 ◽

Vol 23 (4) ◽

pp. 293-300

Author(s):

D. Alex Stroh ◽

Kimona Issa ◽

Samik Banerjee ◽

Jesse Allert ◽

Eiman Shafa ◽

...

Keyword(s):

Risk Factors ◽

Venous Thromboembolism ◽

Lower Extremity ◽

Total Joint Arthroplasty ◽

Joint Arthroplasty

Download Full-text

COVID-19 and cancer registries: learning from the first peak of the SARS-CoV-2 pandemic

British Journal of Cancer ◽

10.1038/s41416-021-01324-x ◽

2021 ◽

Author(s):

Alvin J. X. Lee ◽

Karin Purshouse

Keyword(s):

Risk Factors ◽

Performance Status ◽

Poor Performance ◽

Cancer Registries ◽

Adverse Outcomes ◽

Smoking History ◽

Poor Performance Status ◽

International Studies ◽

Patients With Cancer ◽

Increased Risk

AbstractThe SARS-Cov-2 pandemic in 2020 has caused oncology teams around the world to adapt their practice in the aim of protecting patients. Early evidence from China indicated that patients with cancer, and particularly those who had recently received chemotherapy or surgery, were at increased risk of adverse outcomes following SARS-Cov-2 infection. Many registries of cancer patients infected with SARS-Cov-2 emerged during the first wave. We collate the evidence from these national and international studies and focus on the risk factors for patients with solid cancers and the contribution of systemic anti-cancer treatments (SACT—chemotherapy, immunotherapy, targeted and hormone therapy) to outcomes following SARS-Cov-2 infection. Patients with cancer infected with SARS-Cov-2 have a higher probability of death compared with patients without cancer. Common risk factors for mortality following COVID-19 include age, male sex, smoking history, number of comorbidities and poor performance status. Oncological features that may predict for worse outcomes include tumour stage, disease trajectory and lung cancer. Most studies did not identify an association between SACT and adverse outcomes. Recent data suggest that the timing of receipt of SACT may be associated with risk of mortality. Ongoing recruitment to these registries will enable us to provide evidence-based care.

Download Full-text

Corrigendum to ‘Predictive Risk Factors for 30-day Readmissions Following Primary Total Joint Arthroplasty and Modification of Patient Management’. [The Journal of Arthroplasty 29/10 (2014) 1938–1942]

The Journal of Arthroplasty ◽

10.1016/j.arth.2015.05.054 ◽

2016 ◽

Vol 31 (2) ◽

pp. 559

Author(s):

Samantha Tayne ◽

Christian A. Merrill ◽

Eric L. Smith ◽

William C. Mackey

Keyword(s):

Risk Factors ◽

Total Joint Arthroplasty ◽

Patient Management ◽

Joint Arthroplasty ◽

Predictive Risk

Download Full-text

Incidence of and Risk Factors for 30-Day Readmission Following Elective Primary Total Joint Arthroplasty: Analysis From the ACS-NSQIP

The Journal of Arthroplasty ◽

10.1016/j.arth.2013.06.032 ◽

2013 ◽

Vol 28 (9) ◽

pp. 1499-1504 ◽

Cited By ~ 150

Author(s):

Andrew J. Pugely ◽

John J. Callaghan ◽

Christopher T. Martin ◽

Peter Cram ◽

Yubo Gao

Keyword(s):

Risk Factors ◽

Total Joint Arthroplasty ◽

Joint Arthroplasty ◽

Acs Nsqip

Download Full-text

Tobacco Use Is Associated with More Severe Adverse Outcomes Than Morbid Obesity after Aseptic Revision TKA

The Journal of Knee Surgery ◽

10.1055/s-0041-1731459 ◽

2021 ◽

Author(s):

Michael P. Hagerty ◽

Rafael Walker-Santiago ◽

Jason D. Tegethoff ◽

Benjamin M. Stronach ◽

James A. Keeney

Keyword(s):

Risk Factors ◽

Morbid Obesity ◽

Tobacco Use ◽

Adverse Outcomes ◽

Smoking History ◽

Morbidly Obese ◽

Knee Amputation ◽

Increased Risk ◽

Aseptic Revision ◽

Component Revision

AbstractThe association of morbid obesity with increased revision total knee arthroplasty (rTKA) complications is potentially confounded by concurrent risk factors. This study was performed to evaluate whether morbid obesity was more strongly associated with adverse aseptic rTKA outcomes than diabetes or tobacco use history—when present as a solitary major risk factor. Demographic characteristics, surgical indications, and adverse outcomes (reoperation, revision, infection, and amputation) were compared between 270 index aseptic rTKA performed for patients with morbid obesity (n = 73), diabetes (n = 72), or tobacco use (n = 125) and 239 “healthy” controls without these risk factors at a mean 75.7 (range: 24–111) months. There was no difference in 2-year reoperation rate (17.8 vs. 17.6%, p = 1.0) or component revision rate (8.2 vs. 8.4%) between morbidly obese and healthy patients. However, higher reoperation rates were noted in patients with diabetes (p = 0.02) and tobacco use history (p < 0.01), including higher infection (p < 0.05) and above knee amputation (p < 0.01) rates in patients with tobacco use history. Multivariate analysis retained an independent association between smoking history and amputation risk (odds ratio: 7.4, 95% confidence interval: 1.7–55.2, p < 0.01). Morbid obesity was not associated with an increased risk of reoperation or component revision compared with healthy patients undergoing aseptic revision. Tobacco use was associated with increased reoperation and above knee amputation. Additional study will be beneficial to determine whether risk reduction efforts are effective in mitigating postoperative complication risks.

Download Full-text