scholarly journals Operative Trends in the Treatment of Hip Fractures and the Role of Arthroplasty

2018 ◽  
Vol 9 ◽  
pp. 215145931876063 ◽  
Author(s):  
Luis Grau ◽  
Spencer Summers ◽  
Dustin H. Massel ◽  
Samuel Rosas ◽  
Alvin Ong ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Total Hip Arthroplasty ◽  
Hip Fractures ◽  
Hip Arthroplasty ◽  
Perioperative Complications ◽  
The United States ◽  
Medical Comorbidities ◽  
Total Hip ◽  
Fracture Population

Introduction: There is a projected exponential increase in the number of hip fractures in the United States. Trends in patient demographics and the role of total hip arthroplasty (THA) and its associated outcomes following hip fractures surgery have not been well studied. Methods: Patients with proximal femur fractures between 1990 and 2007 were identified in the National Hospital Discharge Survey database. Demographics, comorbidities, perioperative complications, and discharge status for patients undergoing THA, hemiarthroplasty, or internal fixation were examined. Multivariable regression was performed to determine independent risk factors for perioperative complications. Results: Between 1990 and 2007, there was a statistically significant increase in patient age, adverse events, medical comorbidities, surgical complications, medical complications, and nonroutine discharge across all surgical treatment modalities. In the same time period, the utilization of THA for all fracture types decreased significantly. Discussion: Total hip arthroplasty was found to be an independent risk factor for perioperative complications. Orthopedic surgeons should be aware that the hip fracture population continues to get older, with more medical comorbidities and are at higher risk for perioperative complications. Conclusion: Total hip arthroplasty is associated with a higher rate of perioperative complications in the hip fracture population.

scholarly journals Inequalities in use of total hip arthroplasty for hip fracture: population based study

BMJ ◽  
2016 ◽  
pp. i2021 ◽  
Author(s):  
Daniel C Perry ◽  
David Metcalfe ◽  
Xavier L Griffin ◽  
Matthew L Costa
Keyword(s):  
Hip Fracture ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Population Based ◽  
Population Based Study ◽  
Total Hip ◽  
Fracture Population

scholarly journals The Association of Body Mass Index with Surgical Time Is Mediated by Comorbidity in Patients Undergoing Total Hip Arthroplasty

2021 ◽  
Vol 10 (23) ◽  
pp. 5600
Author(s):  
Francesca Cannata ◽  
Alice Laudisio ◽  
Luca Ambrosio ◽  
Gianluca Vadalà ◽  
Fabrizio Russo ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Total Hip Arthroplasty ◽  
Body Mass ◽  
Hip Arthroplasty ◽  
Perioperative Complications ◽  
Charlson Score ◽  
Surgical Time ◽  
Orthopaedic Practice ◽  
Total Hip

Overweight represents a major issue in contemporary orthopaedic practice. A higher body mass index (BMI) is associated with an increase of perioperative complications following several orthopaedic procedures, in particular total hip arthroplasty (THA). However, the influence of overweight on THA surgical time is controversial. In this study, we investigated the association between BMI and surgical time analyzing the role of patients’ comorbidities. We conducted a retrospective study on 748 patients undergoing THA at our institutions between 2017 and 2018. Information regarding medical diseases was investigated and the burden of comorbidity was quantified using the Charlson score (CCI). Surgical time and blood loss were also recorded. Median surgical time was 76.5 min. Patients with surgical time above the median had both a higher BMI (28.3 vs. 27.1 kg/m2; p = 0.002); and CCI (1 vs. 0; p = 0.016). According to linear regression, surgical time was associated with BMI in the unadjusted model (p < 0.0001), after adjusting for age and sex (p < 0.0001), and in the multivariable model (p = 0.005). Furthermore, BMI was associated with increased surgical time only in patients with a Charlson score above the median, but not in others. Obesity is associated with increased surgical time during THA, especially in pluricomorbid patients, with a higher risk of perioperative complications.

scholarly journals Total Hip Arthroplasty for Hip Fractures: Time to Surgery With Respect to Surgical Revision, Failure, and Mortality

2019 ◽  
Vol 10 ◽  
pp. 215145931881816 ◽  
Author(s):  
Franz Müller ◽  
Michael Galler ◽  
Michael Zellner ◽  
Christian Bäuml ◽  
Stephan Grechenig ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Total Hip Arthroplasty ◽  
Hip Fractures ◽  
Hip Arthroplasty ◽  
Surgical Revision ◽  
Implant Failure ◽  
Total Hip ◽  
Time To Surgery ◽  
Outcome Measurements ◽  
Intracapsular Hip Fracture

Introduction: There are increasing demands to perform surgery of hip fractures without delay. However, few studies have assessed the time to surgery in relation to outcome measurements. Methods: A total of 643 consecutive patients with a minimum age of 60 years underwent total hip arthroplasty (THA) for an intracapsular hip fracture. For this retrospective case series, demographic data and the outcome measurements—(1) any surgical revision, (2) implant failure, and (3) mortality—were documented from a prospective clinical database. The time from admission to surgery was also documented prospectively and then data were divided into 4 groups according to the time of surgery: (1) within 12 hours, (2) >12 to 24 hours, (3) >24 to 48 hours, and (4) later than >48 hours. The study end point was 2 years after surgery. Final evaluation was conducted for any missing data through a telephone interview. Results: The patients comprised 456 women (70.9%) and 187 men (29.1%) with a mean age of 80.2 years (range 60-104 years; standard deviation ±7.4). Descriptive data were without effect in all 4 groups. Time to surgery did not significantly influence revision for any reason ( P = .323), implant failure ( P = .521), and mortality ( P = .643). Cox regression analysis identified male sex ( P < .001; 95% confidence interval (CI), 1.27-2.44), American Society of Anesthesiologists score ≥3 ( P < .001; 95% CI, 2.12-21.59), C-reactive protein level >21 mg/L ( P < .018; 95% CI, 1.09-2.60), hemoglobin level <12.0 g/dL ( P = .033; 95% CI, 1.04-2.68), and dementia ( P < .000; 95% CI, 1.50-2.86) as independent significant risk factors for mortality. Conclusion: Time to surgery had no effect on revision for any reason, implant failure, and mortality in patients undergoing THA for an intracapsular hip fracture.

The Epidemiology of Revision Total Hip Arthroplasty in the United States

2009 ◽  
Vol 24 (2) ◽  
pp. e19
Author(s):  
Kevin J. Bozic ◽  
Steven M. Kurtz ◽  
Edmund Lau ◽  
Kevin Ong ◽  
Thomas P. Vail ◽  
...  
Keyword(s):  
United States ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
The United States ◽  
Revision Total Hip Arthroplasty ◽  
Total Hip

Conversion vs Primary Total Hip Arthroplasty: Increased Cost of Care and Perioperative Complications

2018 ◽  
Vol 33 (8) ◽  
pp. 2405-2411 ◽  
Author(s):  
Sean P. Ryan ◽  
Marcus DiLallo ◽  
David E. Attarian ◽  
William A. Jiranek ◽  
Thorsten M. Seyler
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Perioperative Complications ◽  
Cost Of Care ◽  
Total Hip ◽  
Primary Total Hip Arthroplasty

The serum albumin threshold for increased perioperative complications after total hip arthroplasty is 3.0 g/dL

2018 ◽  
Vol 29 (2) ◽  
pp. 166-171 ◽  
Author(s):  
Charles L Nelson ◽  
Atul F Kamath ◽  
Nabil M Elkassabany ◽  
Zhenggang Guo ◽  
Jiabin Liu
Keyword(s):  
Total Hip Arthroplasty ◽  
Serum Albumin ◽  
Hip Arthroplasty ◽  
Perioperative Complications ◽  
Albumin Level ◽  
Multivariable Logistic Regression Analysis ◽  
Study Cohort ◽  
Odds Ratios ◽  
Total Hip ◽  
Low Serum

Introduction: Low serum albumin is associated with higher perioperative complications following total hip arthroplasty (THA). The distinct threshold for a significant rise in perioperative complications has not been defined for THA. The purpose of this study was to define the threshold at which perioperative complications rise after THA. Methods: We analysed the American College of Surgeons NSQIP database from 2006 to 2013. Our study cohort included unilateral primary THA with reported preoperative albumin levels. Patients were stratified by albumin level. We analysed mortality and 6 composite complication variables (any complication, any complication without transfusion, wound infection, systemic infection, cardiac/pulmonary complications, and any major complication). All data analysis was executed in STATA statistical software. Multivariable logistic regression analysis was used to adjust for odds ratios. Results: The final cohort included 24,586 patients who were stratified based upon serum albumin levels. Odds ratios after multivariable regression adjustment for age, gender, race, body mass index, ASA classification, and Charlson Comorbidity Index indicated a trend to elevated odds of complication for all composite complications (3 of which were statistically significant) when serum albumin level was <3.0 g/dL. Conclusion: Low serum albumin is associated with increased perioperative complications following THA. The threshold associated with an increase in major perioperative complications appears to be an albumin level of <3.0 g/dL. With attempts to correct modifiable risk factors prior to surgery, the threshold value at which perioperative complications increase is important to define.

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