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

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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Outcomes and survivorship after conversion of failed hip hemiarthroplasty to total hip arthroplasty

Hip International ◽

10.1177/1120700019891427 ◽

2019 ◽

pp. 112070001989142 ◽

Cited By ~ 1

Author(s):

Nana O Sarpong ◽

Matthew J Grosso ◽

Akshay Lakra ◽

Carl L Herndon ◽

Emma Jennings ◽

...

Keyword(s):

Postoperative Complications ◽

Total Hip Arthroplasty ◽

Femoral Component ◽

Hip Arthroplasty ◽

Revision Surgery ◽

Complication Rates ◽

Conversion Surgery ◽

Total Hip ◽

Estimated Blood Loss

Background: Arthroplasty is the treatment of choice for elderly patients with displaced femoral neck fractures. When compared to total hip arthroplasty (THA), higher revision rates have been reported for hemiarthroplasty (HA). Conversion of failed HA to THA can be complex, especially in the elderly population at risk for revision surgery complications. We report a single institution’s experience with conversion of failed HA to THA at mid-term follow-up. Methods: We identified patients converted from failed HA to THA from 2006 to 2016. Clinical data including indication for index and conversion surgery, maintenance or revision of femoral component during conversion, operative time, estimated blood loss, postoperative complications, and need for revision surgery were collected. Descriptive statistics were analysed in SPSS. Results: The cohort included 21 men and 39 women (mean age of 74.5 years). The mean follow-up after conversion HA to THA was 2.8 years. During conversion surgery, the femoral component was revised in 75.0% and retained in 25.0% of cases. After conversion HA to THA, the rate of major complications and re-revision at 2 years was 11.7% and 10.0%, respectively. Femoral revision versus retention did not affect complication rates (11.1% vs. 6.7%; p = 0.31) or re-revision rates (8.9% vs. 13.3%; p = 1.0). Conclusions: In this high-risk population, mid-term follow-up demonstrated tolerable complication and re-revision rates, the majority of which were for instability. We observed high rates of femoral component revision during conversion THA, although this did not increase the likelihood of postoperative complications or need for future surgery.

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The effect of time to surgery on outcomes and complication rates following total hip arthroplasty for fractured neck of femur

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2019.0032 ◽

2019 ◽

Vol 101 (5) ◽

pp. 342-345

Author(s):

J Craik ◽

R Geleit ◽

J Hiddema ◽

E Bray ◽

R Hampton ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Length Of Stay ◽

Hip Arthroplasty ◽

Functional Outcomes ◽

Best Practice ◽

Complication Rates ◽

Delayed Presentation ◽

Fractured Neck Of Femur ◽

Neck Of Femur ◽

Total Hip

Introduction Total hip arthroplasty is recommended for elderly patients with fractured neck of femur who are independently mobile, have few co-morbidities and are not cognitively impaired. Providing a daily total hip arthroplasty service is challenging for some units in the UK and considering that these patients may be physiologically distinct from the average hip fracture patient, loss of the best practice tariff as a result of surgical delay may be unjustified. The aim of this study was to determine whether time to surgical intervention for patients eligible for total hip arthroplasty had a negative impact on patient complications, length of stay and functional outcomes. Methods All patients undergoing total hip arthroplasty for fractured neck of femur at our institution over a ten-year period were identified. Complications and functional outcomes were compared between patients receiving total hip arthroplasty before and after 36 hours. Results Of 112 consecutive patients undergoing total hip arthroplasty, 70 responded to a questionnaire or telephone consultation. Four patients were excluded owing to delayed presentation, the presence of advanced rheumatoid arthritis or a pathological fracture. Two-thirds (64%) of the remaining 66 patients underwent surgery within 36 hours of presentation. There were no significant differences between the groups of patients receiving surgery before or after 36 hours with regard to postoperative length of stay, complications, Oxford hip scores or visual analogue scale scores for state of health. Conclusions Delaying surgery for patients eligible for total hip arthroplasty as per the National Institute for Health and Care Excellence guidelines is justified and should not incur loss of the best practice tariff.

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Total Hip Arthroplasty in Patients Younger than 35 Is Effective Regardless of Surgical Approach

The Journal of Hip Surgery ◽

10.1055/s-0040-1714297 ◽

2020 ◽

Vol 4 (03) ◽

pp. 101-109

Author(s):

David Novikov ◽

Tyler A. Luthringer ◽

Zlatan Cizmic ◽

Hayeem L. Rudy ◽

Siddharth Mahure ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Surgical Approach ◽

Operative Time ◽

Postoperative Outcomes ◽

Hospital Length Of Stay ◽

Complication Rates ◽

Robotic Assistance ◽

Leg Length ◽

Total Hip

AbstractDespite the increasing frequency of younger patients undergoing total hip arthroplasty (THA), very few, if any, studies report on postoperative outcomes that specifically compare the two most commonly used approaches in this age group. The purpose of our study is to assess whether surgical approach affects postoperative outcomes in THA patients younger than 35 years. A retrospective analysis of 115 patients younger than 35 years that underwent primary unilateral THA between January 2013 and April 2018 was conducted. Patients were divided into two cohorts: (1) patients that underwent THA utilizing the anterior approach and (2) patients that underwent THA utilizing the posterior approach. Subanalysis controlling for surgical case complexity and use of robotic assistance was performed. Radiographic analysis included measurement of perioperative leg length discrepancies. Of the total 115 patients, 37 were in the anterior THA cohort, and 78 were in the posterior THA cohort. All baseline patient characteristics were similar among both cohorts. Patients in the anterior THA cohort had shorter mean operative times (95 vs. 121 minutes; p < 0.01) and shorter mean hospital length of stay or LOS (1.9 vs. 2.8 days; p < 0.01). Leg length discrepancies, dislocation, revision, and all-cause postoperative complication rates were similar between both cohorts. When excluding complex cases and use of robotic assistance (anterior n = 36, posterior n = 39), there was no difference in operative time, LOS, or postoperative outcomes. Our study suggests that surgically complex patients were more likely to undergo posterior rather than anterior THA. When controlling for surgical complexity and use of robotic assistance, no difference between approach with respect to operative time, hospital LOS, dislocation, revision, and all-cause postoperative surgical complication rates in THA recipients under 35 years of age was found. The results suggest that the anterior and posterior approaches can be equally effective for the majority of young THA patients.

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Is obesity a risk factor for extended length of stay and readmission after total hip arthroplasty?

Annals of Joint ◽

10.21037/aoj.2018.08.03 ◽

2018 ◽

Vol 3 ◽

pp. 73-73

Author(s):

Brian Richard ◽

Austin Reilly ◽

Elizabeth Lyden ◽

Kevin Garvin

Keyword(s):

Risk Factor ◽

Total Hip Arthroplasty ◽

Length Of Stay ◽

Hip Arthroplasty ◽

Total Hip ◽

Extended Length

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Effect of operative time on complications following primary total hip arthroplasty: analysis of the NSQIP database

Hip International ◽

10.1177/1120700020949701 ◽

2020 ◽

pp. 112070002094970

Author(s):

Mark Sikov ◽

Matthew Sloan ◽

Neil P Sheth

Keyword(s):

Total Hip Arthroplasty ◽

Length Of Stay ◽

Hip Arthroplasty ◽

Operative Time ◽

Complication Rates ◽

Improvement Program ◽

Perioperative Morbidity ◽

Total Hip ◽

Risk Of Death ◽

Increased Risk

Background: Long operative times in total hip arthroplasty (THA) have been shown to be associated with increased risk of revision as well as perioperative morbidity. This study assesses the effect of extended operative times on complication rates following primary THA using the most recent national data. Methods: The National Surgical Quality Improvement Program (NSQIP) database (2008–2016) was queried for primary THA. Groups were defined by operative time 1 standard deviation (1 SD) above the mean. Univariate, propensity score-matched, and multivariate logistic regression analyses were performed to evaluate outcomes. Results: Data was available for 135,013 THA patients. Among these groups, mean operative time in the extended operative time group was 166 minutes (compared with 82 minutes). Patients undergoing longer operative times were 3.8 years younger, had a 1.5 kg/m2 higher body mass index and had a 0.5 day longer mean length of stay. Propensity matching identified 16,123 pairs for analysis in the 1 SD group. Longer operative time led to 173% increased risk of major medical morbidity, 140% increased likelihood of length of stay greater than 5 days, 59% increased risk of reoperation, 45% increased risk of readmission, and a 30% decreased likelihood of return to home postoperatively. There was no increased risk of death within 30 days. Conclusion: Long operative times were associated with increases in multiple postoperative complications, but not mortality. Surgeons should be advised to take steps to minimise operative time by adequate preoperative planning and optimal team communication.

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Influence of Spinal and General Anaesthesia on Haemostasis During Total Hip Arthroplasty

Survey of Anesthesiology ◽

10.1097/00132586-198802000-00030 ◽

1988 ◽

Vol 32 (1) ◽

pp. 32???33

Author(s):

F. DAVIS ◽

E. McDERMOTT ◽

C. HICKTON ◽

E. WELLS ◽

D. HEATON ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

General Anaesthesia ◽

Hip Arthroplasty ◽

Total Hip

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Total hip arthroplasty through an anterior approach

EFORT Open Reviews ◽

10.1302/2058-5241.3.180023 ◽

2018 ◽

Vol 3 (11) ◽

pp. 574-583 ◽

Cited By ~ 12

Author(s):

Georgios Kyriakopoulos ◽

Lazaros Poultsides ◽

Panayiotis Christofilopoulos

Keyword(s):

Total Hip Arthroplasty ◽

Length Of Stay ◽

Hip Arthroplasty ◽

Anterior Approach ◽

Formal Training ◽

Long Term Outcomes ◽

Medium Term ◽

Total Hip

Total hip arthroplasty through an anterior approach has been increasing in popularity amongst surgeons and patients. Anterior approach hip arthroplasty seems to offer improved early outcomes in terms of pain, rehabilitation and length of stay. No difference in long-term outcomes has been shown between anterior and posterior or lateral approaches. Proper formal training, utilization of fluoroscopy and adequate experience can mitigate risks of complications and improve early and medium-term outcomes. Cite this article: EFORT Open Rev 2018;3:574-583. DOI: 10.1302/2058-5241.3.180023.

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