Preoperative opioid use is a risk factor for complication following revision total hip arthroplasty

2020 ◽  
pp. 112070002094740
Author(s):  
Jacob M Wilson ◽  
Kevin X Farley ◽  
Greg A Erens ◽  
Thomas L Bradbury ◽  
George N Guild
Keyword(s):  
Risk Factor ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Healthcare Utilisation ◽  
Revision Total Hip Arthroplasty ◽  
Opioid Use ◽  
Opioid Prescription ◽  
Total Hip ◽  
Increased Risk ◽  
Revision Tha

Background: The demand for revision total hip arthroplasty (THA) procedures continues to increase. A growing body of evidence in primary THA suggests that preoperative opioid use confers increased risk for complication. However, it is unknown whether the same is true for patients undergoing revision procedures. The purpose of this study was to investigate whether or not there was a relationship between preoperative opioid use and surgical complications, medical complications, and healthcare utilisation following revision THA. Methods: This is a retrospective cohort study using the Truven Marketscan database. Patients undergoing revision THA were identified. Preoperative opioid prescriptions were queried for 1 year preoperatively and were used to divide patients into cohorts based on temporality and quantity of opioid use. This included an opioid naïve group as well as an “opioid holiday” group (6 months opioid naïve period after chronic use). Demographic and complication data were collected and both univariate and multivariate analysis was then performed. Results: 62.5% of patients had received an opioid prescription in the year preceding surgery. Patients with continuous preoperative opioid use had higher odds of the following: infection (superficial or deep surgical site infection; OR 1.29; 95% CI, 1.03–1.62, p  = 0.029), wound complication (OR 1.36; 95% CI, 1.02–1.82, p = 0.037), sepsis (OR 1.90; 95% CI 1.08–3.34, p = 0.026), and revision surgery (OR 1.54, 95% CI, 1.28–1.85, p < 0.001). This group also had higher care utilisation including extended length of stay, non-home discharge, 90-day readmission, and emergency room visits ( p < 0.001). An opioid holiday mitigated some of this increased risk as this cohort has baseline (i.e. same as opioid naïve) risk ( p > 0.05 for all comparison). Conclusions: Opioid use prior to revision THA is common and is associated with increased risk of postoperative complication. Given that risk was reduced by a preoperative opioid holiday, this represents a modifiable risk factor which should be discussed and addressed preoperatively to optimise outcomes.

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.

Cementation of a dual-mobility cup into a well-fixed cementless shell in patients with high risk of dislocation undergoing revision total hip arthroplasty

2019 ◽  
pp. 112070001987361 ◽  
Author(s):  
Jesús Moreta ◽  
Iker Uriarte ◽  
Xabier Foruria ◽  
Ioar Urra ◽  
Urko Aguirre ◽  
...  
Keyword(s):  
High Risk ◽  
Total Hip Arthroplasty ◽  
Aseptic Loosening ◽  
Hip Arthroplasty ◽  
Recurrent Dislocation ◽  
Revision Total Hip Arthroplasty ◽  
Dual Mobility ◽  
Total Hip ◽  
Revision Tha

Background: Cementation of polyethylene liners into well-fixed cementless metal shells has become an option during revision total hip arthroplasty (THA). We report the results of cementing a dual-mobility (DM) component into a stable acetabular shell in high-risk patients undergoing revision THA. Methods: A single-centre series of 10 patients undergoing revision THA with a DM cup cemented into an existing well-fixed shell between 2012 and 2016 were retrospectively reviewed. Failure due to aseptic loosening or instability and implant survival at last follow-up were analysed. The average age was 79.2 years and mean follow-up was 3.5 years. Indications were recurrent hip dislocation in 8 cases and intraoperative instability with moderate abductor insufficiency in 2 cases. In cases with recurrent dislocation, the aetiology of instability was classified by Wera type. Results: At the latest follow-up, Harris Hip Scores had improved from 49.3 preoperatively to 71.3 postoperatively ( p = 0.098). In the 8 patients with recurrent dislocation, 4 cases (50%) had an unclear aetiology (Wera type 6), 2 (25%) abductor deficiency (Wera type 3) and 2 (25%) late polyethylene wear (type 5). Postoperative recurrent dislocation occurred in 1 hip (10%). No cases of intraprosthetic dislocation, aseptic loosening of the previous shell or dissociation at the cement-cup interface were identified. Conclusion: Although the follow-up of this series is short, cementation of a DM cup into a previous well-fixed socket seems to be a viable option to treat and prevent instability after revision THA, without providing constraint at the cement-cup interface.

scholarly journals Cement Removal from the Femur Using the ROBODOC System in Revision Total Hip Arthroplasty

2013 ◽  
Vol 2013 ◽  
pp. 1-5 ◽  
Author(s):  
Mitsuyoshi Yamamura ◽  
Nobuo Nakamura ◽  
Hidenobu Miki ◽  
Takashi Nishii ◽  
Nobuhiko Sugano
Keyword(s):  
Total Hip Arthroplasty ◽  
Bone Cement ◽  
Hip Arthroplasty ◽  
Weight Bearing ◽  
Full Weight Bearing ◽  
Revision Total Hip Arthroplasty ◽  
Total Hip ◽  
Revision Tha ◽  
Cement Removal

Introduction. The perforation and fracture of the femur during the removal of bone cement in revision total hip arthroplasty (THA) are serious complications. The ROBODOC system has been designed to selectively remove bone cement from the femoral canal, but results have not been reported yet. The purpose of our study was to evaluate the clinical and radiographic results of revision THA using the ROBODOC system for cement removal.Materials and Methods. The subjects comprised 19 patients who underwent revision THA using the ROBODOC system. The minimum duration of follow-up was 76 months (median, 109 months; range, 76–150 months). The extent of remaining bone cement on postoperative radiography, timing of weight bearing, and the complications were evaluated.Results. The mean Merle d’Aubigne and Postel score increased from 10 points preoperatively to 14 points by final follow-up. Bone cement was completely removed in all cases. Full weight bearing was possible within 1 week after surgery in 9 of the 19 cases and within 2 months in all remaining cases. No instances of perforation or fracture of the femur were encountered.Conclusions. Bone cement could be safely removed using the ROBODOC system, and no serious complications occurred. Full weight bearing was achieved early in the postoperative course because of circumferential preservation of the femoral cortex.

scholarly journals Structural and Morselized Allografting Combined with a Cementless Cup for Acetabular Defects in Revision Total Hip Arthroplasty: A 4- to 14-Year Follow-Up

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Hou-Tsung Chen ◽  
Cheng-Ta Wu ◽  
Tsan-Wen Huang ◽  
Hsin-Nung Shih ◽  
Jun-Wen Wang ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Type Ii ◽  
Revision Total Hip Arthroplasty ◽  
Total Hip ◽  
Press Fit ◽  
Cementless Cup ◽  
Revision Tha ◽  
Acetabular Defects

Using morselized and structural allograft to restore bone stock for massive acetabular bone defect in revision total hip arthroplasty (THA) is an appealing procedure. However, concerns about inability to achieve long-term stability following allograft resorption remained. From 2003 to 2012, 59 hips in 58 patients undergoing revision THA for Paprosky type II or III acetabular defects were retrospectively reviewed. The acetabular defects were managed with deep-frozen morselized and structural allografts, and a press-fit cementless cup along with supplementary screws. Clinical outcomes and radiographic results were analyzed with a mean follow-up of 8.7 years. The clinical successful rate was 100% for hips with Paprosky type II defect, 95.2% for IIIA defect, and 92.8% for IIIB defect. Three hips with type III defect failed at 4, 7, and 9 years, respectively. Harris Hip Score improved significantly from 60.1 preoperatively to 91.3 at the latest follow-up. All hips with good clinical results showed trabecular bridging in the allograft-host bone interface. Deep-frozen structural and morselized allograft in combination with a press-fit cementless cup represented a viable option to reconstruct acetabular defects in revision THA.

scholarly journals Extended Trochanteric Osteotomy with Intermediate Resection Arthroplasty Is Safe for Use in Two-Stage Revision Total Hip Arthroplasty for Infection

2021 ◽  
Vol 11 (1) ◽  
pp. 36
Author(s):  
Sebastian Hardt ◽  
Vincent Justus Leopold ◽  
Thilo Khakzad ◽  
Matthias Pumberger ◽  
Carsten Perka ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Femoral Stem ◽  
Femoral Fractures ◽  
Revision Total Hip Arthroplasty ◽  
Trochanteric Osteotomy ◽  
Two Stage ◽  
Total Hip ◽  
Extended Trochanteric Osteotomy ◽  
Revision Tha

Background: This study sought to compare the results of two-stage revision total hip arthroplasty (THA) for periprosthetic infection (PJI) in patients with and without the use of an extended trochanteric osteotomy (ETO) for removal of a well-fixed femoral stem or cement. Methods: Thirty-two patients who had undergone an ETO as part of a two-stage revision without spacer placement were matched 1:2 with a cohort of sixty-four patients of the same sex and age who had stem removal without any osteotomy. Clinical outcomes including interim revision, reinfection and aseptic failure rates were evaluated. Modified Harris hip scores (mHHS) were calculated. Minimum follow-up was two years. Results: Patients undergoing ETO had a significantly lower rate of interim re-debridement compared to non-ETO patients (0% vs. 14.1%, p = 0.026). Reinfection following reimplantation was similar in both groups (12.5% in ETO patients vs. 9.4% in non-ETO patients, p = 0.365). Revision for aseptic reason was necessary in 12.5% in the ETO group and 14.1% in the non-ETO group (p = 0.833). Periprosthetic femoral fractures were seen in three patients (3.1%), of which all occurred in non-ETO patients. Dislocation was the most common complication, which was equally distributed in both groups (12.5%). The mean mHHS was 37.7 in the ETO group and 37.3 in the non-ETO group, and these scores improved significantly in both groups following reimplantation (p < 0.01). Conclusion: ETO without the use of spacer is a safe and effective method to manage patients with well-fixed femoral stems and for thorough cement removal in two-stage revision THA for PJI. While it might reduce the rate of repeated debridement in the interim period, the use of ETO appears to lead to similar reinfection rates following reimplantation.

scholarly journals Defensive antibacterial coating in revision total hip arthroplasty: new concept and early experience

2020 ◽  
Vol 30 (1_suppl) ◽  
pp. 7-11
Author(s):  
Massimo Franceschini ◽  
N Amir Sandiford ◽  
Vincenzo Cerbone ◽  
Lucio Cappelli Toledo de Araujo ◽  
Daniel Kendoff
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Revision Total Hip Arthroplasty ◽  
Short Term ◽  
Total Hip ◽  
Antibacterial Coating ◽  
Revision Tha ◽  
Detailed Function ◽  
New Strategies

Background: Infections remains the most feared complication in total hip arthroplasty (THA). New strategies of PJI prevention includes coating of conventional implants. Defensive Antibacterial Coating (DAC), an antibacterial hydrogel coating made of hyaluronan, poly-D and L-lactide can protect biomaterials as an effective barrier at the time of implantation. In addition, it can be used with topical antibiotics to prevent early colonisation of the implant. Scope: This manuscript describes the detailed function of the DAC in general as well as an analysis of its use in revision THA in a series of 28 patients in a short-term follow-up. Its use in patients undergoing cementless re-implantation after 2-staged procedures in THA is described in detail within the manuscript. Conclusion: DAC found to be effective in terms of infection control and safety in our patient cohort and has been expanded for cementless 1-staged revisions in PJI of the hip in our institution.

scholarly journals Increased risk of complications in patients with hypoalbuminemia undergoing revision total hip arthroplasty

2020 ◽  
Vol 21 ◽  
pp. 253-257 ◽  
Author(s):  
Nicole D. Rynecki ◽  
Dominick V. Congiusta ◽  
Michael Fields ◽  
Rushi Patel ◽  
Michael M. Vosbikian ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Revision Total Hip Arthroplasty ◽  
Total Hip ◽  
Increased Risk

Incidence and risk factors for perioperative death after revision total hip arthroplasty: a 20-year analysis

2020 ◽  
pp. 112070002092135
Author(s):  
Matthew J Best ◽  
Raj M Amin ◽  
Son Nguyen ◽  
Keith T Aziz ◽  
Robert S Sterling ◽  
...  
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Pulmonary Embolism ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Revision Total Hip Arthroplasty ◽  
Total Hip ◽  
Revision Tha ◽  
The Us

Introduction: The number of revision total hip arthroplasty (THA) procedures is increasing in the US. Revision THA is associated with higher complication rates compared with primary THA. We describe patterns in incidence and risk factors for perioperative death after revision THA. Methods: Using the National Hospital Discharge Survey, we identified nearly 700,000 cases of revision THA from 1990 through 2010. Procedure incidence, perioperative mortality rates, comorbidities, discharge disposition, and duration of hospital stay were analysed. Multivariable logistic regression was used to identify independent risk factors for perioperative death. Alpha = 0.01. Results: Population-adjusted incidence of revision THA per 100,000 people increased from 9.2 cases in 1990 to 15 cases in 2010 ( p < 0.001). The rate of perioperative death was 0.9% during the study period and decreased from 1.5% during the “first” period (1990–1999) to 0.5% during the “second” period (2000–2010) ( p < 0.001), despite an increase in comorbidity burden over time. Factors associated with the greatest odds of perioperative death were acute myocardial infarction (odds ratio [OR], 37; 95% confidence interval [CI], 33–40; p < 0.001), pneumonia (OR, 16; 95% CI, 15–18; p < 0.001), and pulmonary embolism (OR, 13; 95% CI, 11–15; p < 0.001). Conclusions: The rate of perioperative death in patients undergoing revision THA in the US decreased from 1990 to 2010 despite an increase in comorbidities. Acute myocardial infarction, pneumonia, and pulmonary embolism were associated with the highest odds of perioperative death after revision THA.

scholarly journals Midterm outcome of fourth-generation ceramic-on-ceramic bearing surfaces in revision total hip arthroplasty

2018 ◽  
Vol 26 (2) ◽  
pp. 230949901878391 ◽  
Author(s):  
Jun-Dong Chang ◽  
In-Sung Kim ◽  
Sameer Ajit Mansukhani ◽  
Vishwas Sharma ◽  
Sang-Soo Lee ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Fourth Generation ◽  
Harris Hip Score ◽  
Revision Total Hip Arthroplasty ◽  
Acetabular Cup ◽  
Total Hip ◽  
Revision Tha ◽  
Ceramic On Ceramic

Purpose: The purpose of this study is to evaluate the clinical and radiologic outcomes after revision total hip arthroplasty (THA) using fourth-generation ceramic-on-ceramic (CoC) bearing surfaces. Methods: A total of 52 revision THAs (28 men and 19 women) using the fourth-generation CoC bearing surfaces were retrospectively evaluated. Both acetabular cup and femoral stem were revised in all cases. The mean follow-up period was 7.3 years (range, 4.0–9.9 years). The clinical results with Harris hip score (HHS), Western Ontario McMaster Osteoarthritis Index (WOMAC), and radiologic outcomes were evaluated. Results: At the final follow-up examination, the average HHS was 90.4 (range, 67–100). The average WOMAC pain and physical function score were 2.8 (range, 0–12) and 16.4 (range, 0–42), respectively. Complications were observed in 10 hips (19.2%). However, there were no bearing surface-related complications, and no cases of dislocation and squeaking. Retroacetabular pelvic osteolysis without cup loosening was observed in one hip at the final follow-up. However, no hip showed radiographic signs of cup loosening, vertical or horizontal acetabular cup migrations, and changes of inclinations during the follow-up period. Conclusion: Our data showed that clinical and radiologic outcomes after revision THA using fourth-generation CoC bearing were favorable. Hence, revision THA with the use of CoC bearing surfaces can be preferentially considered. Further studies with long-term follow-up data are warranted.

scholarly journals Revision Total Hip Arthroplasty Combined with Subtrochanteric Shortening Osteotomy: Case Report

2014 ◽  
Vol 8 (1) ◽  
pp. 49-51 ◽  
Author(s):  
Motoki Sonohata ◽  
Masaru Kitajima ◽  
Syunsuke Kawano ◽  
Hidefumi Honke ◽  
Takao Hotokebuchi ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Revision Surgery ◽  
Hip Prosthesis ◽  
Revision Total Hip Arthroplasty ◽  
New Techniques ◽  
Total Hip ◽  
Shortening Osteotomy ◽  
Revision Tha ◽  
Current Report

Revision surgery is one of the most difficult reconstructive challenges facing orthopaedic surgeons; therefore, many new techniques and implants are needed to ensure that such patient can be successfully treated. We report a 66-year old female with a chronic dislocated bipolar hip prosthesis. She underwent a revision total hip arthroplasty combined with V-shaped subtrochanteric shortening osteotomy. This report demonstrates that V-shaped subtrochanteric shortening osteotomy can be used for revision surgery. Nevertheless, this technique is not suitable for all hip revisions, and the indications and various possible procedures and devices should be carefully considered to select the best treatment for each patient. We believe that the current report provides evidence supporting a new technical option for complex cases during revision THA.

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