Duration of surgery affects the risk of complications following total hip arthroplasty

2019 ◽  
Vol 101-B (6_Supple_B) ◽  
pp. 51-56
Author(s):  
L. L. Nowak ◽  
E. H. Schemitsch
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Operating Time ◽  
Improvement Program ◽  
Surgical Quality ◽  
Total Hip ◽  
Major Complications ◽  
Duration Of Surgery ◽  
American College Of Surgeons ◽  
Multivariable Regression

Aims The aim of this study was to assess the influence of operating time on 30-day complications following total hip arthroplasty (THA). Patients and Methods We identified patients aged 18 years and older who underwent THA between 2006 and 2016 from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. We identified 131 361 patients, with a mean age of 65 years (sd 12), who underwent THA. We used multivariable regression to determine if the rate of complications and re-admissions was related to the operating time, while adjusting for relevant covariables. Results The mean operating time decreased from 118.3 minutes (29.0 to 217.0) in 2006, to 89.6 minutes (20.0 to 240.0) in 2016. After adjustment for covariables, operating times of between 90 and 119 minutes increased the risk of minor complications by 1.2 (95% confidence interval (CI) 1.1 to 1.3), while operating times of between 120 and 179 minutes increased the risk of major complications by 1.4 (95% CI 1.3 to 1.6) and minor complications by 1.4 (95% CI 1.2 to 1.5), and operating times of 180 minutes or more increased the risk of major complications by 2.1 (95% CI 1.8 to 2.6) and minor complications by 1.9 (95% CI 1.6 to 2.3). There was no difference in the overall risk of complications for operating times of between 20 and 39, 40 and 59, or 60 and 89 minutes (p > 0.05). Operating times of between 40 and 59 minutes decreased the risk of re-admission by 0.88 (95% CI 0.79 to 0.97), while operating times of between 120 and 179 minutes, and of 180 minutes or more, increased the risk of re-admission by 1.2 (95% CI 1.1 to 1.3) and 1.6 (95% CI 1.3 to 1.8), respectively. Conclusion These findings suggest that an operating time of more than 90 minutes may be an independent predictor of major and minor complications, as well as re-admission, following THA, and that an operating time of between 40 and 90 minutes may be ideal. Prospective studies are required to confirm these findings. Cite this article: Bone Joint J 2019;101-B(6 Supple B):51–56.

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.

Risk Factors for Early Periprosthetic Fracture after Primary Total Hip Arthroplasty

2020 ◽  
Vol 04 (01) ◽  
pp. 038-044
Author(s):  
Wesley M. Durand ◽  
Morteza Meftah ◽  
Ran Schwarzkopf
Keyword(s):  
Risk Factors ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Periprosthetic Fracture ◽  
Multivariable Analysis ◽  
Adverse Outcomes ◽  
Improvement Program ◽  
Surgical Quality ◽  
Total Hip ◽  
Significant Difference

AbstractPeriprosthetic fracture (PPF) after total hip arthroplasty (THA) is associated with adverse outcomes. Many studies have sought to determine risk factors for PPF, though controversy exists regarding several variables. This study sought to determine risk factors for early PPF using the National Surgical Quality Improvement Program (NSQIP) dataset. Patients with a primary current procedural terminology for THA were identified. The primary outcome was reoperation/readmission for PPF within 30 days. Multivariable logistic regression was utilized to adjust for confounding factors. A total of 159,234 patients were included in the study, of whom 195 patients (0.12%) had a PPF within 30 days, with a mean day of reoperation/readmission of 14.6 (standard deviation 7.7). A total of 68 patients (34.9% of those fractured) underwent one or more reoperations. In multivariable analysis, risk factors for PPF were higher body mass index (BMI; odds ratio [OR] 1.03 per mg/kg2, 95% confidence interval [CI] 1.0–1.05) and higher preoperative leukocyte count (OR 1.04 per 103/mL, 95% CI 1.01–1.06). Among females, age (OR 1.05 per year, 95% CI 1.04–1.07) was significantly associated with PPF, but a similar difference was not observed among males (OR 1.01, 95% CI 0.98–1.04). Controlling for patient age, there was no significant difference in risk of PPF for females versus males (p = 0.2213). PPF was associated with the development of additional complications (OR 4.10, 95% CI 2.68–6.27). This study identified risk factors for PPF after primary THA. These results have implications for preoperative planning and postoperative precautions among patients with particularly elevated risk of PPF.

Preoperative Hyponatremia is a Risk Factor for Adverse 30-Day Outcomes Following Total Hip Arthroplasty

2020 ◽  
Vol 04 (01) ◽  
pp. 007-014
Author(s):  
Joseph E. Tanenbaum ◽  
Thomas T. Bomberger ◽  
Derrick M. Knapik ◽  
Steven J. Fitzgerald ◽  
Nihar S. Shah ◽  
...  
Keyword(s):  
Health Care ◽  
Quality Improvement ◽  
Total Hip Arthroplasty ◽  
Length Of Stay ◽  
Hip Arthroplasty ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Improvement Program ◽  
Surgical Quality ◽  
Total Hip

AbstractThe relationship between preoperative hyponatremia and 30-day outcomes following total hip arthroplasty (THA) is currently unknown. The present study used prospectively collected data to quantify the association between preoperative hyponatremia and odds of major morbidity (MM), longer length of stay, readmission, and reoperation within 30 days following THA. Patients who underwent THA between 2012 and 2014 were identified in the National Surgical Quality Improvement Program database using validated Current Procedural Terminology codes. Patients were included if they were either normonatremic or hyponatremic preoperatively. The outcome measures in this study were 30-day MM, hospital length of stay, 30-day readmission, and 30-day reoperation. A unique multivariable logistic regression model was used for each outcome to identify statistically significant associations between hyponatremia and the outcome of interest after adjusting for covariates. From 2012 to 2014, 59,236 THA procedures were recorded in National Surgical Quality Improvement Program, of which 55,611 patients were normonatremic and 3,051 patients were hyponatremic. After adjusting for covariates, preoperative hyponatremia was significantly associated with increased odds of MM (odds ratio [OR] = 1.14; 99% confidence interval [CI]: 1.01–1.30), 30-day reoperation (OR = 1.18; 99% CI: 1.02–1.36), and longer hospital length of stay (OR = 1.20; 99% CI: 1.13–1.27). Hyponatremia was not significantly associated with greater odds of 30-day readmission (OR = 0.91; 99% CI: 0.82–1.01). Preoperative hyponatremia was significantly associated with adverse 30-day outcomes following THA. As the U.S. health care system continues to transition toward value-based reimbursement that emphasizes health care quality, the results of the present study can be used to improve patient selection and preoperative counseling.

Does robotic-assisted surgery improve outcomes of total hip arthroplasty compared to manual technique? A systematic review and meta-analysis

2021 ◽  
pp. postgradmedj-2021-141135
Author(s):  
Vishal Kumar ◽  
Sandeep Patel ◽  
Vishnu Baburaj ◽  
Rajesh Kumar Rajnish ◽  
Sameer Aggarwal
Keyword(s):  
Systematic Review ◽  
Total Hip Arthroplasty ◽  
Clinical Outcomes ◽  
Hip Arthroplasty ◽  
Meta Analysis ◽  
Operating Time ◽  
Limb Length ◽  
Robot Assisted ◽  
Total Hip

BackgroundRobot-assisted total hip arthroplasty (THA) is an emerging technology that claims to position implants with very high accuracy. However, there is currently limited data in literature on whether this improved accuracy leads to better long-term clinical outcomes. This systematic review compares the outcomes of THA done with the help of robotic assistance (RA) to those done with conventional manual techniques (MTs).MethodsFour electronic databases were searched for eligible articles that directly compared robot-assisted THA to manual THA and had data on the radiological or clinical outcomes of both. Data on various outcome parameters were collected. Meta-analysis was conducted using a random-effects model with 95% CIs.ResultsA total of 17 articles were found eligible for inclusion, and 3600 cases were analysed. Mean operating time in the RA group was significantly longer than in the MT group. RA resulted in significantly more acetabular cups being placed inside Lewinnek’s and Callanan’s safe zones (p<0.001) and had significantly reduced limb length discrepancy compared with MT. There were no statistically significant differences in the two groups in terms of incidence of perioperative complications, need for revision surgery and long-term functional outcome.ConclusionRA leads to highly accurate implant placement and leads to significantly reduced limb length discrepancies. However, the authors do not recommend robot-assisted techniques for routine THAs due to lack of adequate long-term follow-up data, prolonged surgical times and no significant differences in the rate of complications and implant survivorship compared with conventional MTs.

Comorbidities and indications for total hip arthroplasty at a tertiary care center in Saudi Arabia

2021 ◽  
Vol 12 (3) ◽  
pp. 59-63
Author(s):  
Bandar M Hetaimish ◽  
Eyad A Alakkas ◽  
Khalid F Alharbi ◽  
Abdulrahman M Alradadi ◽  
Habib Y Aletani ◽  
...  
Keyword(s):  
Saudi Arabia ◽  
Postoperative Complications ◽  
Total Hip Arthroplasty ◽  
Chronic Diseases ◽  
Hip Arthroplasty ◽  
Common Indication ◽  
Total Hip ◽  
Tertiary Center ◽  
Duration Of Surgery ◽  
Post Traumatic

Objectives: Total hip arthroplasty (THA) is one of the most effective orthopedic interventions for the treatment of patients with advanced‑ stage hip disease. However, reports regarding indications for primary THA in Saudi Arabia are limited. We aimed to evaluate primary indications for THA and identify associated chronic diseases and postoperative complications in THA patients at a tertiary hospital in Saudi Arabia. These are important to provide knowledge on types of hip diseases and variables that may affect the outcome of this intervention in the Saudi population. Methods: This is a retrospective cohort study of THA cases performed between 2010 and 2019 at a tertiary center in Saudi Arabia. Retrieved data include patients’ ages at the time of surgery, chronic diseases, presurgical diagnosis, site and duration of surgery, and postoperative complications. Results: We identified 83 patients who had undergone primary THA; in regard to comorbidities, 32.5% and 30.1% had hypertension and diabetes mellitus, respectively. The most common indication for THA was degenerative hip osteoarthritis (50.6%), followed by post-traumatic arthritis (22.9%) and hip avascular necrosis (20.5%). Conclusion: Despite the high rate of trauma and accidents in Saudi Arabia, degenerative osteoarthritis remains the most common indication for primary THA. Post-traumatic osteoarthritis is identified as the second major indication for THA.

scholarly journals Total hip arthroplasty for high-riding hips: A retrospective analysis of 79 cases and proposal of a new classification

2020 ◽  
Vol 28 (2) ◽  
pp. 230949902092416
Author(s):  
İsmail Demirkale ◽  
Yüksel Uğur Yaradılmış ◽  
Ahmet Ateş ◽  
Murat Altay
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Classification System ◽  
Operating Time ◽  
Limb Length Discrepancy ◽  
Harris Hip Score ◽  
Level Of Evidence ◽  
Total Hip ◽  
Significant Difference ◽  
Functional Scores

Purpose: Total hip arthroplasty (THA) for high-riding hips is a complex procedure and the requirement for subtrochanteric osteotomy (STO) is an important decision that needs to be taken preoperatively. STO renders this complex surgery even more complicated and there are no guidelines to determine the STO requirement. In this study, the outcomes of THA for patients with high-riding hips were evaluated and a practical classification system is proposed to predict any osteotomy requirement. Methods: A retrospective evaluation was made of 79 hips of 76 patients who underwent THA for high-riding hip dysplasia. The amount of shortening in patients with STO and in patients without STO was compared. All patients were evaluated in respect of Harris hip score, operating time, erythrocyte suspension need, and actual limb length discrepancy. Preoperative radiographs were classified into four types according to the ratio of the distance between the lesser trochanter and the ischial tuberosity with pelvic height (LT-IT/P) to grade the degree of dislocation. Results: The mean follow-up was 30 ± 6.54 months. STO was applied to 47 (60%) hips and not to 32 (40%). There was no statistically significant difference between the groups in respect of the functional scores. STO prolonged the operating time and increased the need for blood transfusion ( p = 0.026, p < 0.001, respectively). When the LT-IT/P index was <0.19 (type 1), no additional surgical approach was required for reduction, at 0.19–0.29 (type 2), the head can be safely reduced with additional reduction methods, and when >0.3 (type 3), a shortening osteotomy will most likely be required. The rate of complications is increased if LT-IT/P is >0.4 (type 4). Conclusion: STO adjunct to THA increases the rate of complications. This practical classification system may guide the surgeon in the decision of whether an STO should be added to the procedure or not. Level of evidence: Level III, clinical trial

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