scholarly journals Total Hip Arthroplasty Outperforms Hemiarthroplasty in Patients Aged 65 Years and Older: A Propensity-Matched Study of Short-Term Outcomes

2019 ◽  
Vol 10 ◽  
pp. 215145931987685 ◽  
Author(s):  
Jared A. Warren ◽  
Kavin Sundaram ◽  
Hiba K. Anis ◽  
Nicolas S. Piuzzi ◽  
Carlos A. Higuera ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Short Term ◽  
Improvement Project ◽  
Treatment Pathways ◽  
Total Hip ◽  
Displaced Femoral Neck Fractures ◽  
Increased Risk ◽  
Payment Models

Introduction: Displaced femoral neck fractures in the elderly individuals may be treated with total hip arthroplasty (THA) or hip hemiarthroplasty (HHA). However, it is unclear what the short-term medical outcomes are related to these surgical options. The purpose of this study was to compare early postoperative outcomes in THA patients to those of HHA patients. Methods: In this study, we compared 30-day mortality, likelihood of still being in the hospital at 30 days, postoperative major and minor complications, discharge disposition, reoperation and readmission, length of stay, days from admission to surgery, and operative time between THA and HHA. Using the American College of Surgeons National Surgical Quality Improvement Project database, hip fracture patients ≥65 years old from 2008 to 2016 were identified. After propensity score matching, there were 2795 THAs and 2795 HHAs. To assess the effect of THA on the above-mentioned outcomes, bivariate regression models were created. Results: The THA patients ≥65 years old were at reduced risk for mortality ( P = .029) and still being in the hospital at 30 days ( P = .017). The THA patients were at an increased risk for minor complications ( P = .011) and longer operative times ( P < .001). However, THA patients were more likely to have a home discharge ( P < .001). Discussion: Patients ≥65 years who underwent THA for hip fractures had reduced short-term mortality risk, were more likely to be discharged home, and had less likelihood of being in the hospital at 30 days. This is the first study to explore short-term outcomes in patients ≥65 and has direct implications for alternate payment and merit-based payment models. Conclusion: As hip fracture treatment has come under scrutiny with respect to alternate payment models and merit-based incentive payments, this analysis of short-term outcomes warrants consideration when evaluating treatment pathways.

scholarly journals Dislocation Rate at Short-term Follow-up after Revision Total Hip Arthroplasty with a Dual Mobility Component

2016 ◽  
Vol 6 (1) ◽  
pp. 17-20 ◽  
Author(s):  
Samuel S Wellman ◽  
David E Attarian ◽  
Taylor R McClellan ◽  
Roberto D Calderon ◽  
Paul F Lachiewicz
Keyword(s):  
Total Hip Arthroplasty ◽  
Acetabular Component ◽  
Hip Arthroplasty ◽  
Dislocation Rate ◽  
Revision Total Hip Arthroplasty ◽  
Short Term ◽  
Dual Mobility ◽  
Total Hip ◽  
Increased Risk

ABSTRACT Patients undergoing a revision total hip arthroplasty (THA) are at increased risk for dislocation. The literature suggests dual-mobility components may decrease the frequency of dislocation. We conducted a retrospective study of one type of dual mobility acetabular component implanted in 82 revision THA cases that were considered at increased risk for dislocation. Of the 82 hips, 58 had a mean follow-up of 12 months (3–28 months). The indication for revision was instability in 18 hips (31%), adverse metal-on-metal reaction in 13 hips (22%), reimplantation for infection in 11 hips (19%), and aseptic loosening of the acetabular component in 9 hips (16%). In the course of follow-up, 6 hips developed a deep infection requiring reoperation. There were no early hip dislocations. McClellan TR, Calderon RD, Bolognesi MP, Attarian DE, Lachiewicz PF, Wellman SS. Dislocation Rate at Short-term Follow-up after Revision Total Hip Arthroplasty with a Dual Mobility Component. The Duke Orthop J 2016;6(1):17-20.

Malnutrition increases the 30-day complication and re-operation rates in hip fracture patients treated with total hip arthroplasty

2019 ◽  
Vol 30 (5) ◽  
pp. 635-640
Author(s):  
Jared M Newman ◽  
Nipun Sodhi ◽  
Anton Khlopas ◽  
Nicolas S Piuzzi ◽  
George A Yakubek ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Propensity Scores ◽  
Improvement Program ◽  
Surgical Quality ◽  
Total Hip ◽  
Data Regression ◽  
Increased Risk ◽  
Preoperative Albumin

Introduction: This study sought to determine the effect that malnutrition, defined as hypoalbuminemia, has on hip fracture patients treated with total hip arthroplasty (THA). Specifically, we evaluated: (1) demographics and perioperative data; (2) postoperative complications; and (3) re-operation rates. Methods: The National Surgical Quality Improvement Program database was utilised to identify hip fracture patients who underwent THA from 2008 to 2015. Propensity scores were calculated for the likelihood of having a preoperative albumin measurement. Hip fracture patients who underwent THA and had preoperative hypoalbuminemia (<3.5 g/dL) ( n = 569) were compared to those who had normal albumin levels (⩾3.5 g/dL) ( n = 1098) in terms of demographics and perioperative data. Regression models were adjusted for age, sex, modified Charlson/Deyo scores, and propensity scores to evaluate complication and re-operation rates. Results: Compared to controls, hypoalbuminemia patients were older (p = 0.006), more likely male ( p = 0.024), had higher Charlson/Deyo scores ( p = 0.0001), more likely smokers ( p < 0.0001), more likely functionally dependent ( p < 0.0001), had ASA scores ⩾3 ( p < 0.0001) and had longer LOS ( p < 0.0001). Compared to controls, hypoalbuminemia patients had 80% higher risk for any complication (OR = 1.80; 95% CI, 1.43–2.26), 113% higher risk for major complications (OR = 2.13; 95% CI, 1.31–3.48), and 79% higher risk for minor complications (OR = 1.79; 95% CI, 1.42–2.26), and 97% increased risk for re-operation (OR = 1.97; 95% CI, 1.20–3.23). Conclusions: The findings in the present study indicate the need to develop better pre- and postoperative medical and nutritional care for malnourished hip fracture patients who undergo THA in order to potentially mitigate their increased risk.

Total hip arthroplasty following failed intertrochanteric hip fracture fixation treated with a cephalomedullary nail

2019 ◽  
Vol 101-B (6_Supple_B) ◽  
pp. 91-96 ◽  
Author(s):  
A. Smith ◽  
K. Denehy ◽  
K. L. Ong ◽  
E. Lau ◽  
D. Hagan ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Hip Fracture ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Fracture Fixation ◽  
Salvage Procedure ◽  
Total Hip ◽  
Intertrochanteric Hip Fracture ◽  
Lower Socioeconomic ◽  
Increased Risk

Aims Cephalomedullary nails (CMNs) are commonly used for the treatment of intertrochanteric hip fractures. Total hip arthroplasty (THA) may be used as a salvage procedure when fixation fails in these patients. The aim of this study was to analyze the complications of THA following failed intertrochanteric hip fracture fixation using a CMN. Patients and Methods Patients who underwent THA were identified from the 5% subset of Medicare Parts A/B between 2002 and 2015. A subgroup involving those with an intertrochanteric fracture that was treated using a CMN during the previous five years was identified and compared with the remaining patients who underwent THA. The length of stay (LOS) was compared using both univariate and multivariate analysis. The incidence of infection, dislocation, revision, and re-admission was compared between the two groups, using multivariate analysis adjusted for demographic, hospital, and clinical factors. Results The Medicare data yielded 56 522 patients who underwent primary THA, of whom 369 had previously been treated with a CMN. The percentage of THAs that were undertaken between 2002 and 2005 in patients who had previously been treated with a CMN (0.346%) more than doubled between 2012 and 2015 (0.781%). The CMN group tended to be older and female, and to have a higher Charlson Comorbidity Index and lower socioeconomic status. The mean LOS was 1.5 days longer (5.3 vs 3.8) in the CMN group (p < 0.0001). The incidence of complications was significantly higher in the CMN group compared with the non-CMN group: infection (6.2% vs 2.6%), dislocation (8.1% vs 4.5%), revision (8.4% vs 4.3%), revision for infection (1.1% vs 0.37%), and revision for dislocation (2.2% vs 0.6%). Conclusion The incidence of conversion to THA following failed intertrochanteric hip fracture fixation using a CMN continues to increase. This occurs in elderly patients with increased comorbidities. There is a significantly increased risk of infection, dislocation, and LOS in these patients. Patients with failed intertrochanteric hip fracture fixation using a CMN who require THA should be made aware of the increased risk of complications, and steps need to be taken to reduce this risk. Cite this article: Bone Joint J 2019;101-B(6 Supple B):91–96.

scholarly journals Predicting life expectancy after geriatric hip fracture: A systematic review

PLoS ONE ◽  
2021 ◽  
Vol 16 (12) ◽  
pp. e0261279
Author(s):  
Alexander Lee ◽  
Sara Weintraub ◽  
Ianto Lin Xi ◽  
Jaimo Ahn ◽  
Joseph Bernstein
Keyword(s):  
Systematic Review ◽  
Hip Fracture ◽  
Total Hip Arthroplasty ◽  
Life Expectancy ◽  
Hip Arthroplasty ◽  
Survival Data ◽  
Sufficient Information ◽  
Total Hip ◽  
Displaced Femoral Neck Fractures ◽  
Geriatric Hip Fracture

Background Displaced femoral neck fractures in geriatric patients are typically treated with either hemiarthroplasty or total hip arthroplasty. The choice between hemiarthroplasty and total hip arthroplasty requires a good estimate of the patient’s life expectancy, as the recent HEALTH trial suggests that the benefits of the two operations do not diverge, if at all, until the second year post-operatively. A systematic review was this performed to determine if there sufficient information in the medical literature to estimate a patient’s life expectancy beyond two years and to identify those patient variables affecting survival of that duration. Methods Pubmed, Embase, and Cochrane databases were queried for articles reporting survival data for at least two years post-operatively for at least 100 patients, age 65 or greater, treated surgically for an isolated hip fracture. A final set of 43 papers was created. The methods section of all selected papers was then reviewed to determine which variables were collected in the studies and the results section was reviewed to note whether an effect was reported for all collected variables. Results There were 43 eligible studies with 25 unique variables identified. Only age, gender, comorbidities, the presence of dementia and fracture type were collected in a majority of studies, and within that, only age and gender were reported in a majority of the results. Most (15/ 25) variables were reported in 5 or fewer of the studies. Discussion There are important deficiencies in the literature precluding the evidence-based estimation of 2 year life expectancy. Because the ostensible advantages of total hip arthroplasty are reaped only by those who survive two years or more, there is a need for additional data collection, analysis and reporting regarding survival after geriatric hip fracture.

Short-Term Outcomes of Total Hip Arthroplasty After Complications of Open Reduction Internal Fixation for Hip Fracture

2006 ◽  
Vol 21 (5) ◽  
pp. 682-688 ◽  
Author(s):  
Mitchell Winemaker ◽  
Patrick Gamble ◽  
Danielle Petruccelli ◽  
Sarkis Kaspar ◽  
Justin de Beer
Keyword(s):  
Hip Fracture ◽  
Total Hip Arthroplasty ◽  
Internal Fixation ◽  
Hip Arthroplasty ◽  
Open Reduction ◽  
Open Reduction Internal Fixation ◽  
Short Term ◽  
Total Hip

Short-term outcomes vary by surgical approach in total hip arthroplasty: a network meta-analysis

2021 ◽  
Author(s):  
Aaron Gazendam ◽  
Anthony Bozzo ◽  
Seper Ekhtiari ◽  
Colin Kruse ◽  
Nancy Hiasat ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Surgical Approach ◽  
Meta Analysis ◽  
Short Term ◽  
Total Hip

Safety of vitamin E-infused highwall liners for routine use in primary total hip arthroplasty: single centre, short-term follow-up of 1221 cases

2020 ◽  
pp. 112070002096964
Author(s):  
Kirill Gromov ◽  
Nanna H Sillesen ◽  
Thomas Kallemose ◽  
Henrik Husted ◽  
Henrik Malchau ◽  
...  
Keyword(s):  
Patient Safety ◽  
Vitamin E ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Single Centre ◽  
Short Term ◽  
Total Hip ◽  
Arthroplasty Registry ◽  
Primary Total Hip Arthroplasty

Background: Introduction of new implants should be monitored closely to capture any signs of compromising patient safety. Vitamin E infused highly-crosslinked polyethylene liners (VEPE) offer the potential for reduced wear. Highwall liners have been hypothesised to result in increased wear and potential liner fractures. The aim of this study was to determine the 3–7-year follow-up of highwall VEPE for primary total hip arthroplasty (THA), focusing on liner-related complications. Methods: We included 1221 consecutive THA operations from July 2010 to May 2014 with minimum follow-up of 3 (3.1–6.8) years Data collected included demographics, implant data, complications, reoperations, and deaths. Data were cross-referenced with the Danish Hip Arthroplasty Registry in order to ensure validity and completeness. Acetabular shell position was measured using Martell Hip Analysis Suite in a subgroup of 931 THAs. Results: Cumulative stem revision and shell revision at 3-year follow-up was 3.4% and 0.4% respectively. There were no revisions due to liner failure. Reason for revision included 11 dislocations, 15 soft-tissue revisions for infection, 44 stem revisions of which 34 were periprosthetic fractures and 13 shell revisions of which 6 were combined shell and stem revisions. Conclusion: Early follow-up of VEPE liners for primary THA have not shown any revisions associated with liner failure. Continued monitoring of new materials are necessary to capture any signs of compromised patient safety.

Short-Term Outcomes and Complications After Rejuvenate Modular Total Hip Arthroplasty Revision

2016 ◽  
Vol 31 (4) ◽  
pp. 857-862 ◽  
Author(s):  
Brian T. Barlow ◽  
John W. Boles ◽  
Yuo-yu Lee ◽  
Philippe A. Ortiz ◽  
Geoffrey H. Westrich
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Short Term ◽  
Total Hip ◽  
Arthroplasty Revision
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