scholarly journals Posterior approach, fracture diagnosis, and American Society of Anesthesiology class III–IV are associated with increased risk of revision for dislocation after total hip arthroplasty: An analysis of 33,337 operations from the Finnish Arthroplasty Register

2020 ◽  
pp. 145749692093061
Author(s):  
V. J. Panula ◽  
E. M. Ekman ◽  
M. S. Venäläinen ◽  
I. Laaksonen ◽  
R. Klén ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Confidence Interval ◽  
Hip Arthroplasty ◽  
Head Size ◽  
Anterolateral Approach ◽  
Class Iii ◽  
Arthroplasty Register ◽  
Total Hip ◽  
American Society ◽  
Hip Arthroplasties

Background and Aims: Dislocation is one of the most common reasons for revision surgery after primary total hip arthroplasty. Both patient related and surgical factors may influence the risk of dislocation. In this study, we evaluated risk factors for dislocation revision after total hip arthroplasty based on revised data contents of the Finnish Arthroplasty Register. Materials and Methods: We analyzed 33,337 primary total hip arthroplasties performed between May 2014 and January 2018 in Finland. Cox proportional hazards regression was used to estimate hazard ratios with 95% confidence intervals for first dislocation revision using 18 potential risk factors as covariates, such as age, sex, diagnosis, hospital volume, surgical approach, head size, body mass index, American Society of Anesthesiology class, and fixation method. Results: During the study period, there were 264 first-time revisions for dislocation after primary total hip arthroplasty. The hazard ratio for dislocation revision was 3.1 (confidence interval 1.7–5.5) for posterior compared to anterolateral approach, 3.0 (confidence interval 1.9–4.7) for total hip arthroplasties performed for femoral neck fracture compared to total hip arthroplasties performed for osteoarthritis, 2.0 (confidence interval 1.0–3.9) for American Society of Anesthesiology class III–IV compared to American Society of Anesthesiology class I, and 0.5 (0.4–0.7) for 36-mm femoral head size compared to 32-mm head size. Conclusion: Special attention should be paid to patients with fracture diagnoses and American Society of Anesthesiology class III–IV. Anterolateral approach and 36-mm femoral heads decrease dislocation revision risk and should be considered for high-risk patients.

Should National Standards for Reporting Surgical Site Infections Distinguish between Primary and Revision Orthopedic Surgeries?

2010 ◽  
Vol 31 (05) ◽  
pp. 503-508 ◽  
Author(s):  
Surbhi Leekha ◽  
Priya Sampathkumar ◽  
Daniel J. Berry ◽  
Rodney L. Thompson
Keyword(s):  
Total Hip Arthroplasty ◽  
Confidence Interval ◽  
Hip Arthroplasty ◽  
Odds Ratio ◽  
Risk Index ◽  
National Standards ◽  
Revision Total Hip Arthroplasty ◽  
Total Hip ◽  
Hip Arthroplasties ◽  
Primary Total Hip Arthroplasty

Objective. To compare the surgical site infection (SSI) rate after primary total hip arthroplasty with the SSI rate after revision total hip arthroplasty. Design. Retrospective cohort study. Setting. Mayo Clinic in Rochester, Minnesota, a referral orthopedic center. Patients. All patients undergoing primary total hip arthroplasty or revision total hip arthroplasty during the period from January 1, 2002, through December 31, 2006. Methods. We obtained data on total hip arthroplasties from a prospectively maintained institutional surgical database. We reviewed data on SSIs collected prospectively as part of routine infection control surveillance, using the criteria of the Centers for Disease Control and Prevention for the definition of an SSI. We used logistic regression analyses to evaluate differences between the SSI rate after primary total hip arthroplasty and the SSI rate after revision total hip arthroplasty. Results. A total of 5,696 total hip arthroplasties (with type 1 wound classification) were analyzed, of which 1,381 (24%) were revisions. A total of 61 SSIs occurred, resulting in an overall SSI rate of 1.1% for all total hip arthroplasties. When stratified by the National Nosocomial Infection Surveillance (NNIS) risk index, SSI rates were 0.5%, 1.2%, and 1.6% in risk categories 0, 1, and 2, respectively. After controlling for the NNIS risk index, the risk of SSI after revision total hip arthroplasty was twice as high as that after primary total hip arthroplasty (odds ratio, 2.2 [95% confidence interval, 1.3-3.7]). In the analysis restricted to the development of deep incisional or organ space infections, the risk of SSI after revision total hip arthroplasty was nearly 4 times that after primary total hip arthroplasty (odds ratio, 3.9 [95% confidence interval, 2.0-7.6]). Conclusion. Including revision surgeries in the calculation of SSI rates can result in higher infection rates for institutions that perform a larger number of revisions. Taking NNIS risk indices into account does not eliminate this effect. Differences between primary and revision surgeries should be considered in national standards for the reporting of SSIs.

Trends in Total Hip Arthroplasty in Young Patients - Results from a Regional Register

2017 ◽  
Vol 27 (5) ◽  
pp. 443-448 ◽  
Author(s):  
Amit Kumar ◽  
Benjamin V. Bloch ◽  
Colin Esler
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Young Patients ◽  
Activity Level ◽  
Arthroplasty Register ◽  
Total Hip ◽  
The United Kingdom ◽  
Acetabular Fixation ◽  
Hip Arthroplasties ◽  
The Ideal

Introduction In the United Kingdom, over 83,000 primary total hip arthroplasties (THAs) were performed last year, of which 20% are in patients under the age of 60 years. These patients generally have a longer life expectancy and a higher activity level than an older cohort, which may potentially translate to higher revision rates. Methods We reviewed our Trent regional arthroplasty register to assess current surgical practice in younger patients undergoing total hip arthroplasty. The results were compared to a previous study published in 2005. Results Between 2010 and 2012, 1,097 primary THAs were performed on patients aged 54 or less. There was an equal cohort of males to females with a mean age of 46 years of patients undergoing THA. Osteoarthritis was the commonest aetiology for patients having surgery. Reviewing the components used there were 32 different femoral and 30 different acetabular types along with 70 different combinations of components. There were 608 uncemented THAs, 313 hybrid THRs, 98 cemented THAs, 67 resurfacing arthroplasties and 11 reverse hybrid THAs. Discussion The majority of implants were uncemented in both femur and acetabulum with consultants performing most of the procedures. There is a clear preference for uncemented femoral and acetabular fixation in the younger patient, and the trend towards uncemented components has increased over the last 10 years amongst the same surgeons. There continues to be a wide variety of cup and stem usage along with many different combinations of components, with no consensus on the ideal combination.

Assessment of an Orthopaedic Templating Software Package for Uncemented Total Hip Arthroplasty

2020 ◽  
Vol 4 (04) ◽  
pp. 155-157
Author(s):  
Michael Newman ◽  
David Hartwright
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Acetabular Cup ◽  
Total Hip ◽  
Pelvic Radiograph ◽  
Uncemented Total Hip Arthroplasty ◽  
Femoral Stems ◽  
Hip Arthroplasties ◽  
Acetabular Components ◽  
Insight Into

AbstractThe aim of this study was to assess a large, single-surgeon dataset of uncemented total hip arthroplasties that had been templated using software. This assessment compared preoperative templated predictions with what was implanted with regard to (1) femoral prosthesis size and (2) acetabular cup size. The operation notes for two types of uncemented total hip arthroplasty performed by a single surgeon between January 9, 2008, and March 21, 2019, were assessed. The data were refined so that only those that were fully templated on a correctly calibrated pelvic radiograph were included. This provided a total of 153 cases. The predicted software template was compared with actual implanted component sizes. With regard to the femoral stems, the templating software was exactly correct in 45.75% of cases and was accurate to within one size in 87.59% of cases. With regard to the acetabular component, the templating software was exactly correct in 52.94% of cases and was accurate to within one size (2 mm) in 86.94% of cases. Templating software offers an accurate prediction of the size of uncemented femoral and acetabular components. In addition, the benefits of templating include cognitive rehearsal, insight into potentially challenging aspects of surgery, and highlighting intraoperative issues where there is a large intraoperative deviation from what is templated. This study demonstrates the congruence and reproducibility of templating software when compared with other smaller studies performed in the literature.

Anterolateral approach for total hip arthroplasty

2004 ◽  
Vol 15 (2) ◽  
pp. 79-82
Author(s):  
Matthew S. Austin ◽  
William J. Hozack
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Anterolateral Approach ◽  
Total Hip

Is There a Benefit to Head Size Greater Than 36 mm in Total Hip Arthroplasty?

2016 ◽  
Vol 31 (1) ◽  
pp. 152-155 ◽  
Author(s):  
Bryan D. Haughom ◽  
Darren R. Plummer ◽  
Mario Moric ◽  
Craig J. Della Valle
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Head Size ◽  
Total Hip
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