scholarly journals Non-compliance with clinical guidelines increases the risk of complications after primary total hip and knee joint replacement surgery

PLoS ONE ◽  
2021 ◽  
Vol 16 (11) ◽  
pp. e0260146
Author(s):  
Helen Mary Badge ◽  
Tim Churches ◽  
Justine M. Naylor ◽  
Wei Xuan ◽  
Elizabeth Armstrong ◽  
...  
Keyword(s):  
Clinical Guidelines ◽  
High Volume ◽  
Deep Infection ◽  
Total Hip ◽  
Joint Replacement Surgery ◽  
Replacement Surgery ◽  
Post Surgery ◽  
Increased Risk ◽  
Adjusted Logistic Regression ◽  
One Year

Background Total hip and total knee replacement (THR/TKR) are common and effective surgeries to reduce the pain and disability associated with arthritis but are associated with small but significant risks of preventable complications such as surgical site infection (SSI) and venous-thrombo-embolism (VTE). This study aims to determine the degree to which hospital care was compliant with clinical guidelines for the prevention of SSI and VTE after THR/TKR; and whether non-compliant prophylaxis is associated with increased risk of complications. Methods and findings A prospective multi-centre cohort study was undertaken in consenting adults with osteoarthritis undergoing elective primary TKR/THR at one of 19 high-volume Australian public or private hospitals. Data were collected prior to surgery and for one-year post-surgery. Four adjusted logistic regression analyses were undertaken to explore associations between binary non-compliance and the risk of surgical complications: (1) composite (simultaneous) non-compliance with both (VTE and antibiotic) guidelines and composite complications [all-cause mortality, VTE, readmission/reoperation for joint-related reasons (one-year) and non-joint-related reasons (35-days)], (2) VTE non-compliance and VTE outcomes, (3) antibiotic non-compliance and any SSI, and (4) antibiotic non-compliance and deep SSI. Data were analysed for 1875 participants. Guideline non-compliance rates were high: 65% (VTE), 87% (antibiotics) and 95% (composite guideline). Composite non-compliance was not associated with composite complication (12.8% vs 8.3%, adjusted odds ratio [AOR] = 1.41, 95%CI 0.68–3.45, p = 0.40). Non-compliance with VTE guidelines was associated with VTE outcomes (5% vs 2.4%, AOR = 2.83, 95%CI 1.59–5.28,p < 0.001). Non-compliance with antibiotic guidelines was associated with any SSI (14.8% vs 6.1%, AOR = 1.98, 95%CI 1.17–3.62,p = 0.02) but not deep infection (3.7% vs 1.2%,AOR = 2.39, 95%CI 0.85–10.00, p = 0.15). Conclusions We found high rates of clinical variation and statistically significant associations between non-compliance with VTE and antibiotic guidelines and increased risk of VTE and SSI, respectively. Complications after THR/TKR surgery may be decreased by improving compliance with clinical guidelines.

scholarly journals Validity of patient-reported complications after total hip and knee arthroplasty

2018 ◽  
Vol 26 (3) ◽  
pp. 230949901880249 ◽  
Author(s):  
Kinh Luan Thanh Dang ◽  
Helen Badge ◽  
Ian A Harris
Keyword(s):  
Knee Arthroplasty ◽  
High Volume ◽  
Total Hip ◽  
Joint Replacement Surgery ◽  
Patient Reports ◽  
Replacement Surgery ◽  
Telephone Interviews ◽  
Patient Reported ◽  
Hip And Knee Arthroplasty ◽  
High Level

Background: Evaluating the effectiveness of total hip arthroplasty (THA) and total knee arthroplasty (TKA) often relies on accurate patient reporting of postoperative complications. Despite this, there is little research regarding the accuracy of patient reports. We aimed to determine the accuracy of patient-reported significant complications after THA and TKA. Methods: Patients were recruited prior to undergoing primary hip or knee arthroplasty at 19 high-volume hospitals. After surgery, follow-up of patients via telephone interviews at 35, 90 and 365 days recorded surgical outcomes including readmission, reoperation and venous thromboembolism (VTE). Patient-reported complications were verified via medical record audits and liaison with surgeons, general practitioners or other health professionals. Surgical and demographic information and patient-reported and verified complications were entered into a database. Patient-reported and verified complications were compared for readmission, reoperation and VTE. Results: The sample included 150 of 1811 patients who reported a total of 242 significant complications. Of the 242 patient-reported complications, 224 (92.6%) were correct (true positive). The type of complication had variable levels of accuracy in patient reports. Readmission to hospital was accurately reported by 90.2% (129/143) of patients. Reoperation (including any manipulations under anaesthesia, joint washouts, reductions of dislocated joints and revisions) was accurately reported by 98.7% (75/76) of patients. VTE was accurately reported by 86.7% (20/23) of patients. Conclusion: A high level of accuracy in patient-reported experience of complications was demonstrated following THA and TKA. Patient-reported complications may be reliably used for post-operative surveillance of joint replacement surgery.

MRSA-free Elective Orthopaedic Surgery. A Dedicated Elective Orthopaedic Ward Free from MRSA Alexandra Hospital, Redditch, UK

2005 ◽  
Vol 15 (3) ◽  
pp. 171-176
Author(s):  
A. Datta ◽  
A. Gardner ◽  
K. Bell
Keyword(s):  
Infection Rate ◽  
High Volume ◽  
Deep Infection ◽  
Healthcare Associated Infection ◽  
Joint Replacement Surgery ◽  
Replacement Surgery ◽  
Hip Replacements ◽  
Great Scrutiny ◽  
Orthopaedic Ward ◽  
Healthcare Associated

Deep infection complicating arthroplasty surgery carries a heavy financial and emotional burden on any orthopaedic service. The cost of hospital acquired infection is estimated at £1 billion per year by the National Audit Office. Healthcare associated infection is an area currently under great scrutiny. The Alexandra Hospital, Redditch, has developed a dedicated elective orthopaedic ward free from methicillin-resistant Staphylococcus aureus (MRSA) that delivers high quality and high volume major joint replacement surgery through rigorous infection control. Between October 2001 and December 2002, the Alexandra Hospital had an infection rate of 0.21% for total knee replacements compared to the national rate of 2.1% p= 0.002 (CI 0.00005-0.01) The infection rate for total hip replacements was 1.31% compared to 3.8% nationwide. p= 0.01 (CI 0.004- 0.03). The total number of joint replacements performed per year, utilising the same number of elective beds, increased from 482 in 2001 to 629 in 2002. We believe that the MRSA screening policy and subsequent altered bed utilisation have contributed to lowering the rate of infection and improved efficiency. We have developed a safe, effective and efficient orthopaedic unit within the framework of an acute NHS trust. We believe the practical changes and modest investment that have been made within our department can be repeated in other units around the country with relative ease.

scholarly journals Social profile and cost analysis of deep infection following total hip replacement surgery

2017 ◽  
Vol 52 (6) ◽  
pp. 720-724
Author(s):  
Vera Lucia Frazão ◽  
Helder de Souza Miyahara ◽  
Ricardo Akihiro Kirihara ◽  
Ana Lucia Lei Munhoz Lima ◽  
Alberto Tesconi Croci ◽  
...  
Keyword(s):  
Cost Analysis ◽  
Total Hip Replacement ◽  
Hip Replacement ◽  
Deep Infection ◽  
Total Hip ◽  
Replacement Surgery ◽  
Hip Replacement Surgery

Experimental and numerical static failure analyses of total hip replacement interfaces

2019 ◽  
Vol 233 (11) ◽  
pp. 1183-1195
Author(s):  
Sait Kocak ◽  
Tezcan Sekercioglu
Keyword(s):  
Total Hip Replacement ◽  
Hip Replacement ◽  
Mechanical Tests ◽  
Test Methods ◽  
Element Analysis ◽  
Cement Interface ◽  
Total Hip ◽  
Joint Replacement Surgery ◽  
Replacement Surgery ◽  
Material Choice

In joint replacement surgery, the critical point in the success of cemented implants is the stabilisation between the implant and bone. The stronger the interlocking achieved on both the implant–cement interface and the cement–bone interface, the more durable is the surgical intervention. However, to date, it has not been possible to prevent aseptic loosening of hip implants, thus making a revision surgery necessary after a period of about 10 years. In this study, the tensile and shear strengths of the implant–cement and cement–bone interfaces and factors which can affect these strengths such as sandblasting parameters and implant material choice were investigated experimentally. The stresses on the total hip replacement interfaces were then determined via finite element analysis and the findings compared with the strength values obtained from the mechanical tests. The total hip replacement prosthesis was designed using SolidWorks software, and material properties and boundary conditions were modelled with the ANSYS Workbench software. Stresses due to the loads applied to the femur head had exceeded the highest tensile and shear strength values obtained by the classical test methods and damaged the contact surfaces in some regions. In light of these findings, the damage sites of the interfaces were determined.

scholarly journals The journey to total hip or knee replacement

2012 ◽  
Vol 36 (2) ◽  
pp. 130 ◽  
Author(s):  
Julie Lynette Walters ◽  
Shylie Mackintosh ◽  
Lorraine Sheppard
Keyword(s):  
Joint Replacement ◽  
Elective Surgery ◽  
Public Hospitals ◽  
Patient Journey ◽  
Total Hip ◽  
Joint Replacement Surgery ◽  
Replacement Surgery ◽  
Patient Pathway ◽  
Total Knee ◽  
Insight Into

Objectives. Despite the incidence of joint replacements in Australia, there is a paucity of information regarding how patients progress from their referral to their surgery. The aim of this study was to describe a patient pathway from referral to receipt of total hip replacement (THR) or total knee replacement (TKR) surgery in South Australian public hospitals. Methods. Patient perspectives of the pathway to THR and TKR surgery were obtained via a postal survey (n = 450) and hospital employee perspectives were attained via semi-structured interviews (n = 19). Survey data were analysed using descriptive statistics and interview data were analysed thematically. Results. A typical patient pathway to THR and TKR surgery can be divided into two distinct phases; referral-to-initial appointment (9–24 months), and initial appointment-to-surgery (12–15 months). This gives an overall waiting period between 2 and 3 years for THR or TKR surgery. Conclusions. Waiting times for THR and TKR surgery reported in this study were longer than other reports in the literature. Current Australian health policy does not consider the first (and longest) phase of the patient pathway. Excluding this initial phase could be generating an erroneous perception of the patient pathway to THR or TKR surgery, possibly leading to poorly considered health reforms. What is known about the topic? Meeting the demand for elective surgery services in public hospitals is an ongoing challenge for governments and health systems alike. The persistent mismatch between supply and demand has resulted in the development of waiting lists for elective total hip replacement (THR) and total knee (TKR) replacement surgery in Australia. Current state-level health policies such as the Policy Framework and Associated Procedural Guidelines for Elective Surgery Services in South Australia or the Elective Surgery Access Policy in Victoria, outline a generic pathway consisting of a few linear steps that occur immediately before receipt of surgery, without consideration of the early stages of the journey. Aside from these types of policies, we were unable to identify any published literature outlining the patient journey from referral to receipt of THR or TKR surgery. As such, our understanding of the issue is inadequate due the paucity of existing research evidence. What does this paper add? Our current understanding of the patient journey to THR and TKR surgery is limited to the perspective of the policy-makers, whose focus is the organisation of waiting lists and the systematic progression of an individual through the elective surgery system. This perspective reinforces the assumption that it is a simple, linear process and may lead to erroneous judgements regarding the impact that the patient pathway has on an individual and the time it takes to progress along that pathway. This study presents the patient pathway from the perspective of individuals working within the systems responsible for delivering THR and TKR surgery and from patients who have received a joint replacement in a South Australian public hospital. As such, this paper provides new insight into the length, impact and features of the entire patient journey, rather than a snap-shot of the final stages. What are the implications for practitioners? This study is the first step towards better understanding of the patient pathway to joint replacement surgery in Australian public hospitals. Greater understanding of the complete pathway and identification of areas of congestion within the pathway, as evidenced by longer waiting periods, offers insight into areas with the potential for effective reforms. Should the patient pathway be significantly altered, the experience of practitioners responsible for the interim and postoperative management of patients undergoing THR and TKR surgery will also be changed. Additionally, practitioners currently frustrated by the long delays experienced by their patients who are in need of elective surgery in Australian public hospitals, could have that frustration abated by system improvements that reduce the length and complexity of the pathway to joint replacement surgery.

160 - Anti-TNF Inhibitors are not Associated with Increased Risk of Infection after Joint Replacement Surgery

2018 ◽  
Vol 154 (6) ◽  
pp. S-44-S-45
Author(s):  
Martin H. Gregory ◽  
Andrew McKinnon ◽  
Dustin Stwalley ◽  
Edward V. Loftus ◽  
K.J. Hippensteel ◽  
...  
Keyword(s):  
Joint Replacement ◽  
Tnf Inhibitors ◽  
Risk Of Infection ◽  
Joint Replacement Surgery ◽  
Replacement Surgery ◽  
Increased Risk

scholarly journals REDUCED INFECTION RATE AFTER ASEPTIC REVISION TOTAL HIP ARTHROPLASTY WITH EXTENDED ORAL ANTIBIOTIC PROTOCOL

2018 ◽  
Vol 1 (1) ◽  
Author(s):  
Amer Mohiuddin, BS ◽  
Justin Rice, BA ◽  
Mary Ziemba-Davis, BA ◽  
R. Michael Meneghini, MD
Keyword(s):  
Total Hip Arthroplasty ◽  
Infection Rate ◽  
Hip Arthroplasty ◽  
Joint Infection ◽  
Deep Infection ◽  
Oral Antibiotic ◽  
Revision Total Hip Arthroplasty ◽  
Total Hip ◽  
Aseptic Revision ◽  
One Year

Background and Hypothesis: Periprosthetic joint infection (PJI is a leading cause of failure after aseptic revision total hip arthroplasty (RTHA). While well documented in the primary setting, perioperative antibiotic duration is not well described in RTHA where the risk of PJI was recently reported to be 8% one-year post-revision. The study purpose was to evaluate whether extended oral antibiotic prophylactic protocol minimizes PJI in aseptic RTHA patients compared to the published literature.   Project Methods: 169 consecutive aseptic RTHAs performed with modern perioperative and infection-prevention protocols by a single surgeon at a single center were retrospectively reviewed. 80% of patients were discharged on 7-day oral antibiotic prophylaxis while intra-operative cultures were incubating. Infections and reoperations were documented.   Results: Average age and BMI were 63 years and 30 kg/m2.  67% percent of patients were ASA-III/IV, signifying the severity of comorbidities in this revision cohort. There we no cases of PJI in the 90-day postoperative period. Ninety-eight percent of cases were infection free at mean follow-up of 45 months. Three (1.8%) cases underwent reoperation for deep infection at 110, 161 and 581 days.    Conclusion and Potential Impact: Our observed infection rate of 0.0% is lower than published infection rates following RTHA and a 1.5% infection rate in primary THA in patients with no identifiable risk factors for PJI.  Based on this clinically meaningful decrease in PJI in this challenging cohort, we encourage further study regarding extended antibiotic protocol weighed appropriately against potential consequences.   

scholarly journals Early Experiences with Indigenous Medicated Spacers in the Management of Infected Hip Prosthesis.

2013 ◽  
Vol 11 (1) ◽  
pp. 32-36
Author(s):  
Pankaj Chand ◽  
Suchil Rana Magar ◽  
Bishnu Babu Thapa ◽  
Bachhu Ram KC ◽  
Amit Joshi ◽  
...  
Keyword(s):  
Hip Prosthesis ◽  
Revision Arthroplasty ◽  
Recurrent Infection ◽  
Cost Effective ◽  
Deep Infection ◽  
Two Stage ◽  
Joint Replacement Surgery ◽  
Replacement Surgery ◽  
Walking Capacity ◽  
Postoperative Dislocation

Introduction: Joint replacement surgery, has become one of the most frequent prosthetic surgeries over the past decades due to its success in restoring function to disabled arthritic individual. A two-stage revision arthroplasty is a well-accepted method for the treatment of a deep infection of a hip with a joint implant. In the present study, the results of three infected hips with the interim use of an indigenous cemented prosthesis along with gentamycin impregnated cement beads were assessed with a two stage revision. Methods: Three consecutive patients who were managed with a two-stage revision hip arthroplasty for the treatment of a previous infection, with retained implants, were followed clinically and radiographically for an average of 15 months. Following removal of implants and debridement (first stage), an indigenous medicated prosthesis along with antibiotic coated cement beads were implanted, for an interim phase of six - eight weeks aft er which a new prosthesis was placed ( second stage ).In this period antibiotics ( both intravenous and oral) were administered to the patients. Results: In a mean follow up period of 15 months, there is no evidence of recurrent infection in all three patients, as of now. The use of antibiotic coated cement prosthesis along with gentamycin mixed cement beads was associated with a satisfactory hip score, and better walking capacity in the interim period, a lower transfusion requirement at the time of reimplantation, and no postoperative dislocation. Conclusions: Locally prepared medicated spacer and gentamycin coated beads help in eradicating hip infection, besides being more cost effective. Medical Journal of Shree Birendra Hospital; Jan-June 2012/vol.11/Issue1/32-36 DOI: http://dx.doi.org/10.3126/mjsbh.v11i1.7765

scholarly journals Profiles of Biomarkers of Excess Alcohol Consumption in Patients Undergoing Total Hip Replacement: Correlation with Function

2011 ◽  
Vol 11 ◽  
pp. 1804-1811 ◽  
Author(s):  
Paul J. Jenkins ◽  
Andrew D. Duckworth ◽  
Francis P. C. Robertson ◽  
Colin R. Howie ◽  
James S. Huntley
Keyword(s):  
Total Hip Replacement ◽  
Hip Replacement ◽  
Alcohol Misuse ◽  
Future Research ◽  
Total Hip ◽  
Increased Risk ◽  
Functional Scores ◽  
Hip Function ◽  
One Year ◽  
General Physical

Aims. Patients who misuse alcohol may be at increased risk of surgical complications and poorer function following hip replacement. Identification and intervention may lead to harm reduction and improve the outcomes of surgery. The aim of this study was to determine the prevalence of biomarker elevation in patients undergoing hip replacement and to investigate any correlation with functional scores and complications.Methods. We performed a retrospective study that examined the profile of biomarkers of alcohol misuse in 1049 patients undergoing hip replacement.Results. Gamma-glutamyltransferase was elevated in 150 (17.6%), and mean corpuscular volume was elevated in 23 (4%). At one year general physical health was poorer where there was elevation ofγGT, and the mental health and hip function was poorer with elevation of MCV. There were no differences in complications.Discussion. Raised biomarkers can alert clinicians to potential problems. They also provide an opportunity to perform further investigation and offer intervention. Future research should focus on the use in orthopaedic practice of validated screening questionnaires and more sensitive biomarkers of alcohol misuse.Conclusion. This study demonstrates a potential substantial proportion of unrecognised alcohol misuse that is associated with poorer functional scores in patients after total hip replacement.

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