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 Is implant sonication useful when screening for infection in conversion of prior hip fracture fixation to total hip arthroplasty?

2021 ◽  
Vol 49 (9) ◽  
pp. 030006052110281
Author(s):  
Yannick Palmowski ◽  
Matthias Pumberger ◽  
Carsten Perka ◽  
Sebastian Hardt ◽  
Christian Hipfl
Keyword(s):  
Treatment Outcome ◽  
Hip Fracture ◽  
Total Hip Arthroplasty ◽  
Internal Fixation ◽  
Hip Arthroplasty ◽  
Fracture Fixation ◽  
Microbiological Analysis ◽  
Total Hip ◽  
Osteosynthesis Material ◽  
Cutibacterium Acnes

Objective To examine sonication results in presumed aseptic conversion total hip arthroplasty (THA) after hip fracture fixation and to evaluate its implications on the treatment outcome. Methods This retrospective cohort study reviewed the data from presumed aseptic patients that underwent conversion of prior internal fixation of proximal femoral fractures to THA between 2012 and 2018. Microbiological analysis was performed using sonication of osteosynthesis material and tissue samples. Treatment outcome including the occurrence of periprosthetic joint infection (PJI) was recorded. Results A total of 32 patients were included in the study. Of these, five patients (15.6%) had positive intraoperative cultures. The mean follow-up following conversion THA was 43.0 months (range, 19.0–91.5 months). Sonication was positive in three patients (9.4%), all of whom were deemed contaminated and did not develop PJI. Tissue cultures were positive in two patients (6.3%). One patient with Enterococcus faecalis received antibiotic treatment and did not develop PJI. Another patient with growth of Cutibacterium acnes that was initially classified as a contaminant later developed acute PJI caused by the same pathogen. Overall, PJI occurred in two patients (6.3%) after conversion THA. Conclusion Sonication of internal fixation devices did not add diagnostic value in clinically aseptic conversion THA. Further studies are needed to better understand the relevance of unexpected positive cultures, and to develop diagnostic criteria for the management of these patients.

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.

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.

Conversion total hip arthroplasty for early failure following unstable intertrochanteric hip fracture: what can patients expect?

2021 ◽  
Author(s):  
Blake J. Schultz ◽  
Chelsea Sicat ◽  
Aleks Penev ◽  
Ran Schwarzkopf ◽  
Kenneth A. Egol
Keyword(s):  
Hip Fracture ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Early Failure ◽  
Total Hip ◽  
Intertrochanteric Hip Fracture

Is osteonecrosis due to systemic lupus erythematosus associated with increased risk of complications following total hip arthroplasty?

2018 ◽  
Vol 42 (7) ◽  
pp. 1485-1490 ◽  
Author(s):  
Dennis Q. Chen ◽  
Jourdan M. Cancienne ◽  
Brian C. Werner ◽  
Quanjun Cui
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Lupus Erythematosus ◽  
Systemic Lupus ◽  
Total Hip ◽  
Increased Risk

scholarly journals Total hip arthroplasty after hip fracture

BMJ ◽  
2016 ◽  
pp. i2217 ◽  
Author(s):  
Harman Chaudhry
Keyword(s):  
Hip Fracture ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Total Hip

scholarly journals Inequalities in access to total hip arthroplasty for hip fracture: a population-based study

The Lancet ◽  
2016 ◽  
Vol 387 ◽  
pp. S81
Author(s):  
Daniel Perry ◽  
David Metcalfe ◽  
Matthew Costa
Keyword(s):  
Hip Fracture ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Population Based ◽  
Population Based Study ◽  
Total Hip

Risk Factors for Periprosthetic Femoral Fracture in Non-cemented Total Hip Arthroplasty Through the Direct Anterior Approach

2021 ◽  
pp. 155633162110508
Author(s):  
Zachary Berliner ◽  
Cameron Yau ◽  
Kenneth Jahng ◽  
Marcel A. Bas ◽  
H. John Cooper ◽  
...  
Keyword(s):  
Risk Factors ◽  
Total Hip Arthroplasty ◽  
Parkinson Disease ◽  
Hip Arthroplasty ◽  
Femoral Fracture ◽  
Categorical Variables ◽  
Patient Specific ◽  
Periprosthetic Femoral Fracture ◽  
Total Hip ◽  
Increased Risk

Background: Although total hip arthroplasty (THA) performed through the direct anterior (DA) approach is frequently marketed as superior to other approaches, there are concerns about increased risks of intraoperative and early postoperative femoral fracture. Purpose: We sought to assess patient-specific and radiographic risk factors for intraoperative and early postoperative (90-day) periprosthetic femoral fracture (PPFx) following DA approach THA. Methods: We retrospectively reviewed 1107 consecutive, primary, non-cemented DA THAs, performed between April 2009 and January 2015, for intraoperative and early postoperative PPFx. Patients lost to follow-up before 90 days (63), cemented or hybrid THA (52), or early femoral failure for another indication (3) were excluded, yielding 989 hips for analysis. Demographic variables and patient comorbidities were analyzed as risk factors for PPFx. Continuous variables were initially compared with 1-way analysis of variance (ANOVA) and categorical variables with chi-square test. A demographic matched-paired radiographic analysis was performed for femoral stem canal fill and compared using univariate logistic regression. Results: The incidence of perioperative PPFx was 2.02%, including 10 intraoperative and 10 early postoperative fractures. Sustaining a postoperative PPFx was associated with being 70 years old or older with a body mass index (BMI) of less than 25, or with having either osteoporosis or Parkinson disease. Radiographs demonstrated that intraoperative PPFx was associated with stems that filled greater proximally rather than distally. Conclusion: Our cohort study found older age, age over 70 with BMI of less than 25, osteoporosis, and Parkinson disease were associated with increased risk for early postoperative PPFx following DA approach THA. Intraoperative fractures may occur with disproportionate proximal femoral canal fill. Further study can evaluate whether cemented femoral components may mitigate risk in these patient populations.

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