Incision site fat thickness and 90-day complications for direct anterior and posterior approach total hip arthroplasty

2020 ◽  
pp. 112070002097716
Author(s):  
Gregory R. Sprowls ◽  
Bryce C Allen ◽  
Kathleen F Lundquist ◽  
Lauren N Sager ◽  
Clint D Barnett
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Joint Infection ◽  
Subcutaneous Fat ◽  
Wound Complications ◽  
Total Hip ◽  
Incision Site ◽  
Lateral Incision ◽  
Fat Thickness ◽  
The Relationship

Background: Defining the distribution of subcutaneous fat around the hip in relation to different approaches for total hip arthroplasty (THA) may lead to a better understanding of the relationship between obesity and complications. The purpose of this study was to: (1) describe the intraoperative thickness of subcutaneous fat at the incision site for direct anterior (DAA) and posterior approaches (PA) for THA; and (2) examine the relationship between fat thickness and 90-day postoperative complications. Methods: Intraoperative fat measurements were obtained at the anterior incision site (AT-IS) of the DAA ( n = 60) and the lateral incision site (LT-IS) of the PA ( n = 64). Lateral hip fat thickness was measured from preoperative anteroposterior pelvis radiographs (LT-XR). Body mass index (BMI), sex, age, and 90-day complications were collected retrospectively. Results: Patients within the same demographic groupings had significantly more fat laterally than anteriorly, between 9.6 mm and 17.96 mm. Return to the OR was significantly associated with BMI, AT-IS, and LT-IS. Wound complications were significantly associated with AT-IS. Periprosthetic joint infection (PJI) was significantly associated with BMI and LT-IS. No outcome variables were associated with LT-XR, approach, sex, or age. LT-XR was strongly correlated with AT-IS and LT-IS. Conclusions: Regardless of BMI, sex, or age more soft tissue was encountered with a PA compared to a DAA. General adiposity was associated with return to the OR. Excess incisional fat was associated with wound complications following a DAA and PJI after a PA. LT-XR and clinical examination near the proposed incision, may provide helpful data in making preoperative risk assessments.

Surgical approach does not affect deep infection rate after primary total hip arthroplasty

2019 ◽  
Vol 29 (6) ◽  
pp. 597-602 ◽  
Author(s):  
Georgios K Triantafyllopoulos ◽  
Stavros G Memtsoudis ◽  
Haijun Wang ◽  
Yan Ma ◽  
Michael M Alexiades ◽  
...  
Keyword(s):  
Risk Factors ◽  
Total Hip Arthroplasty ◽  
Length Of Stay ◽  
Hip Arthroplasty ◽  
Joint Infection ◽  
Posterolateral Approach ◽  
Wound Complications ◽  
Total Hip ◽  
Discharge Disposition ◽  
Increased Risk

Background: There is a concern for higher rates of wound complications and a potentially increased periprosthetic joint infection (PJI) risk after total hip arthroplasty (THA) with the direct anterior approach (DAA) compared to the posterolateral approach (PLA). Our purpose was to compare PJI risk after THA with the DAA or the PLA and to identify risk factors for PJI after primary THA. Methods: Clinical characteristics of patients treated in our institution with primary DAA or PLA THA between 1/2010 and 12/2015 were retrospectively reviewed. The respective deep PJI rates were calculated. A logistic regression model was constructed to determine a potential difference in the PJI risk between the 2 groups, and risk factors for hip PJI in all patients. Results: During the period studied, there were 1,182 DAA THAs and 18,853 PLA THAs. The PJI rate was 0.25% for the DAA group and 0.31% for the PLA group ( p = 1.0). The DAA was not associated with a significantly increased risk for PJI compared to the PLA. Compared to younger patients, older patients had lower PJI risk; patient discharge to home was also associated with lower PJI risk compared to other discharge disposition; longer length of stay was associated with higher PJI risk compared to shorter length of stay. Conclusion: The DAA is equally safe compared the PLA with respect to PJI risk. Younger age, discharge to facilities other than home and increased length of stay increase the risk for deep PJI after primary THA.

scholarly journals Does peritrochanteric fat thickness increase the risk of early reoperation for infection or wound complications following total hip arthroplasty?

2019 ◽  
Vol 16 (5) ◽  
pp. 359-362
Author(s):  
Joshua A. Bell ◽  
Andrew Jeong ◽  
Daniel D. Bohl ◽  
Brett Levine ◽  
Craig Della Valle ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Wound Complications ◽  
Thickness Increase ◽  
Total Hip ◽  
Fat Thickness ◽  
Early Reoperation

Novel radiographic hip fat thickness ratio correlates with early re-operation following total hip arthroplasty

2021 ◽  
pp. 112070002199178
Author(s):  
Erdem A Sezgin ◽  
Ali K Ali ◽  
M Baybars Ataoğlu ◽  
Özlem Orhan ◽  
Mustafa Odluyurt ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Interobserver Reliability ◽  
Subcutaneous Fat ◽  
Thickness Measurement ◽  
Continuous Variable ◽  
Thickness Ratio ◽  
Early Failure ◽  
Total Hip ◽  
Fat Thickness

Introduction: Obesity is thought to lead to increased failure rates following total hip arthroplasty (THA). Site-specific fat distribution has been suggested to be a better indicator of risk, compared to body mass index. Fat thickness measurement methods were developed for total knee arthroplasty, however, there is limited data on the methods for THA. The aim of this study was to assess the interobserver and intraobserver reliability of a newly defined radiographic subcutaneous fat thickness ratio and investigate the correlation of this ratio with early failure following THA. Methods: 321 patients who underwent primary THA at a single institution between 2014 and 2017, with at least 1-year of follow-up and a preoperative pelvis anteroposterior x-ray radiograph were included in this study. A high hip fat thickness ratio (HFTR) was arbitrarily defined as ⩾2. Early failure was defined as revision or re-operation for any reason and death related to operation first year following THA. Results: The HFTR was shown to have excellent intraobserver and interobserver reliability. High HFTR was associated with higher risk of early failure following THA (odds ratio 3.8, [95% confidence interval, 1.2–12.1], p < 0.05). The same association persisted when HFTR was analysed as a continuous variable ( p < 0.01) and in multivariate analysis ( p < 0.05). Conclusions: HFTR can be used to assess periarticular soft tissue distribution and may be regarded as a useful and reproducible tool for assessing risk of early failure following THA.

Treatment for Chronic Hepatitis C Prior to Total Hip Arthroplasty Significantly Reduces Periprosthetic Joint Infection

2019 ◽  
Vol 34 (1) ◽  
pp. 132-135 ◽  
Author(s):  
Hany S. Bedair ◽  
Brian M. Schurko ◽  
Maureen K. Dwyer ◽  
David Novikov ◽  
Afshin A. Anoushiravani ◽  
...  
Keyword(s):  
Chronic Hepatitis ◽  
Hepatitis C ◽  
Total Hip Arthroplasty ◽  
Chronic Hepatitis C ◽  
Hip Arthroplasty ◽  
Periprosthetic Joint Infection ◽  
Joint Infection ◽  
Total Hip

The effect of bearing surface on risk of periprosthetic joint infection in total hip arthroplasty

2018 ◽  
Vol 100-B (2) ◽  
pp. 134-142 ◽  
Author(s):  
A. T. Hexter ◽  
S. M. Hislop ◽  
G. W. Blunn ◽  
A. D. Liddle
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Periprosthetic Joint Infection ◽  
Observational Studies ◽  
Meta Analysis ◽  
Joint Infection ◽  
Risk Of Bias ◽  
Cochrane Library ◽  
Bearing Surface ◽  
Total Hip

Aims Periprosthetic joint infection (PJI) is a serious complication of total hip arthroplasty (THA). Different bearing surface materials have different surface properties and it has been suggested that the choice of bearing surface may influence the risk of PJI after THA. The objective of this meta-analysis was to compare the rate of PJI between metal-on-polyethylene (MoP), ceramic-on-polyethylene (CoP), and ceramic-on-ceramic (CoC) bearings. Patients and Methods Electronic databases (Medline, Embase, Cochrane library, Web of Science, and Cumulative Index of Nursing and Allied Health Literature) were searched for comparative randomized and observational studies that reported the incidence of PJI for different bearing surfaces. Two investigators independently reviewed studies for eligibility, evaluated risk of bias, and performed data extraction. Meta-analysis was performed using the Mantel–Haenzel method and random-effects model in accordance with methods of the Cochrane group. Results Our search strategy revealed 2272 studies, of which 17 met the inclusion criteria and were analyzed. These comprised 11 randomized controlled trials and six observational studies. The overall quality of included studies was high but the observational studies were at high risk of bias due to inadequate adjustment for confounding factors. The overall cumulative incidence of PJI across all studies was 0.78% (1514/193 378). For each bearing combination, the overall incidence was as follows: MoP 0.85% (1353/158 430); CoP 0.38% (67/17 489); and CoC 0.53% (94/17 459). The meta-analysis showed no significant difference between the three bearing combinations in terms of risk of PJI. Conclusion On the basis of the clinical studies available, there is no evidence that bearing choice influences the risk of PJI. Future research, including basic science studies and large, adequately controlled registry studies, may be helpful in determining whether implant materials play a role in determining the risk of PJI following arthroplasty surgery. Cite this article: Bone Joint J 2018;100-B:134–42.

Recalcitrant Periprosthetic Joint Infection With Iliac Fossa Abscess After Total Hip Arthroplasty

2021 ◽  
Author(s):  
Kuo-Ti Peng ◽  
Tsung-Yu Huang ◽  
Jiun-Liang Chen ◽  
Chiang-Wen Lee ◽  
Hsin-Nung Shih
Keyword(s):  
Total Hip Arthroplasty ◽  
Treatment Failure ◽  
Hip Arthroplasty ◽  
Periprosthetic Joint Infection ◽  
Iliac Fossa ◽  
Joint Infection ◽  
Treatment Success ◽  
Anterolateral Approach ◽  
Total Hip ◽  
Orthopedic Procedure

Abstract Background: Total hip arthroplasty (THA) is a widely used and successfully performed orthopedic procedure for treating severe hip osteoarthritis, rheumatoid arthritis, and avascular necrosis. However, periprosthetic joint infection (PJI) after THA is a devastating complication for patients and orthopedic surgeons. Although surgical technology has been advanced and antibiotic-loaded cemented spacers or beads have developed, the treatment failure rate of one- or two-stage exchange arthroplasty for PJI is reported to be high, with >10% rate of incidence. Therefore, determining the possible pathogenesis and increasing the treatment success rate is a clinically important and urgent issue. Methods: A total of 256 patients with PJI who had undergone THA from 2005 to 2015 were included in this retrospective review. Seven patients required combined ilioinguinal and anterlateoal approach for debridement of iliac fossa abscess and infected hip lesion, included five patients with intraoperative pus leakage from the acetabular inner wall and the other two patients who underwent pre-operative pelvic computed tomography (CT) because of repeat PJI treatment failure. All available data from the medical records from all patients were retrospectively analyzed.Results: Of the 256 patients, seven (3.1%) patients was combined iliac fossa abscess in our cohort. For the microbiologic analysis, a total of thirteen pathogens were isolated from seven recurrent PJI patients with iliac fossa abscess, and Staphylococus aureus was the most commomly pathogen (4 out of 7 cases). The serum white blood cell (WBC) count was decreased significantly two weeks after debridement with combined the ilioinguinal and anterolateral approach compared to the day before surgery (11840/μL vs. 7370/μL; p<0.01), and level of C-reactive protein (CRP) was decreased at postoperative one week (107 mg/dL vs. 47.31 mg/dL; p=0.03). Furthermore, no recurrent infection was found in six revision THA patient in a follow up of 7.1 year. Conclusion: This result suggests that pre-operative pelvic CT and cautious identification of uncertain pus leakage from the inner wall of the acetabulum is essential for the diagnosis of recurrent PJI. Radical debridement with combined ilioinguinal and anterlateoal approach may aviod treatment failure in recurrent PJI with iliac fossa abscess.

scholarly journals Predictive value of lateral soft tissue thickness for complications after total hip arthroplasty with a lateral incision

2020 ◽  
Vol 33 (3) ◽  
pp. 336-341
Author(s):  
Gregory R. Sprowls ◽  
Bryce C. Allen ◽  
Travis J. Wilson ◽  
Jessica E. Pruszynski ◽  
Kendall A. P. Hammonds
Keyword(s):  
Soft Tissue ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Predictive Value ◽  
Tissue Thickness ◽  
Total Hip ◽  
Soft Tissue Thickness ◽  
Lateral Incision
Sign in / Sign up

Export Citation Format

Share Document