Epidural Versus General Anaesthesia for Total Hip Arthroplasty in Elderly Patients

In this prospective, randomised, double-blind study, we investigated the effect of epidural anaesthesia and an antifibrinolytic agent, Aprotinin (500,000 KIU in bolus before surgery and 500,000 KIU h-1 in drip form during surgery), on intra and postoperative blood loss and transfusion requirements in total hip arthroplasty. Sixty patients were allocated randomly to four groups (A: epidural + general anesthesia + Aprotinin, B: epidural + general anesthesia + placebo (equal volume), C: general anaesthesia + Aprotinin, D: general anaesthesia + placebo). Postoperative analgesia: epidural analgesia in groups A and B, systemic analgesia with opiates in groups C and D. Blood loss during surgery was monitored and salvaged with the Compact-A Dideco, and postoperative blood loss with the BT 797 Recovery Dideco for the first 24 hours. Perioperative blood loss, frequency and quantity of transfusions were significantly higher in group D (p < 0.0001). Total blood loss was reduced by 31.3% by epidural anaesthesia, 20.4% by Aprotinin and 51.4% using a combination of the two techiniques.

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Neuraxial anaesthesia is associated with improved outcomes and reduced postoperative complications in patients undergoing aseptic revision total hip arthroplasty

Hip International ◽

10.1177/1120700020975749 ◽

2020 ◽

pp. 112070002097574

Author(s):

Chapman Wei ◽

Alex Gu ◽

Arun Muthiah ◽

Safa C Fassihi ◽

Peter K Sculco ◽

...

Keyword(s):

Postoperative Complications ◽

Total Hip Arthroplasty ◽

Length Of Stay ◽

General Anaesthesia ◽

Hip Arthroplasty ◽

Postoperative Outcomes ◽

Complication Rates ◽

Total Hip ◽

Neuraxial Anaesthesia ◽

Extended Length

Background: As the incidence of primary total hip arthroplasty (THA) continues to increase, revision THA (rTHA) is becoming an increasingly common procedure. rTHA is widely regarded as a more challenging procedure, with higher complication rates and increased medical, social and economic burdens when compared to its primary counterpart. Given the complexity of rTHA and the projected increase in incidence of these procedures, patient optimisation is becoming of interest to improve outcomes. Anaesthetic choice has been extensively studied in primary THA as a modifiable risk factor for postoperative outcomes, showing favourable results for neuraxial anaesthesia compared to general anaesthesia. The impact of anaesthetic choice in rTHA has not been studied previously. Methods: A retrospective study was performed using the American College of Surgeons National Surgical Quality Improvement Program database. Patients who underwent rTHA between 2014 and 2017 were divided into 3 anaesthesia cohorts: general anaesthesia, neuraxial anaesthesia, and combined general-regional (neuraxial and/or peripheral nerve block) anaesthesia. Univariate and multivariate analyses were used to analyse patient characteristics and 30-day postoperative outcomes. Bonferroni correction was applied for post-hoc analysis. Results: In total, 5759 patients were identified. Of these, 3551 (61.7%) patients underwent general anaesthesia, 1513 (26.3%) patients underwent neuraxial anaesthesia, and 695 (12.1%) patients underwent combined general-regional anaesthesia. On multivariate analysis, neuraxial anaesthesia was associated with decreased odds for any-one complication (OR 0.635; p < 0.001), perioperative blood transfusion (OR 0.641; p < 0.001), and extended length of stay (OR 0.005; p = 0.005) compared to general anaesthesia. Conclusions: Relative to those receiving general anaesthesia, patients undergoing neuraxial anaesthesia are at decreased risk for postoperative complications, perioperative blood transfusions, and extended length of stay. Prospective controlled trials should be conducted to verify these findings.

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Total hip arthroplasty for intertrochanteric fracture fixation failure

European Journal of Medical Research ◽

10.1186/s40001-019-0398-1 ◽

2019 ◽

Vol 24 (1) ◽

Cited By ~ 2

Author(s):

Liyun Liu ◽

Yongqiang Sun ◽

Linlin Wang ◽

Qiankun Gao ◽

Ang Li ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Elderly Patients ◽

Internal Fixation ◽

Hip Arthroplasty ◽

Fracture Fixation ◽

Intertrochanteric Fracture ◽

Joint Function ◽

Fixation Failure ◽

Total Hip ◽

Sf 36

Abstract Background Intertrochanteric fracture is a common fracture suffered by elderly patients. Total hip arthroplasty (THA) is regarded as a salvage operation to restore hip joint function after fixation failure, which remains somewhat controversial due to some clinical potential issues. Methods 18 elderly patients (average age 70.3 years) each with intertrochanteric fracture fixation failure treated with THA between September 2013 and October 2016 were retrospectively analyzed. Internal fixation treatments involved 5 patients who had received proximal femoral nail anti-rotation, 7 who received locking proximal femur plates and 6 who received dynamic hip screws. All patients were treated with THA using biological acetabular prosthesis and hip arthroplasty (HA) coating skillet femoral prosthesis, with the greater trochanter fixed using wire or steel when necessary. Patients’ Harris scores pre- and post-treatment, SF-36 Health Questionnaire score and digital radiology (DR) were used for joint prostheses initial stability and survival evaluation. Results 15 patients completed follow-up periods ranging between 19 and 54 months (mean 26.2 months; 1 patient died from a pulmonary embolism, 1 patient died from pulmonary heart disease 1 year after surgery and 1 patient withdrew for personal reasons). There were no joint infections, periprosthetic fractures or dislocations. The average Harris score increased significantly, from 32.68 ± 12.04 points before surgery to 91.08 ± 5.9 points at 24 months post-treatment. SF-36 scores were significantly increased. Conclusion THA as salvage treatment for failed internal fixation of intertrochanteric femoral fractures in elderly patients significantly reduced hip pain and restored joint function, and early clinical outcomes were satisfactory.

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