Total Hip Arthroplasty: Increased Risk of Venous Thromboembolism Even with Appropriate Prophylaxis

2013 ◽  
Vol 3 (2) ◽  
pp. e3
Author(s):  
Jay R. Lieberman
Keyword(s):  
Venous Thromboembolism ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Total Hip ◽  
Increased Risk

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.

The effect of patient point of entry and Medicaid status on quality outcomes following total hip arthroplasty

2020 ◽  
Vol 102-B (7_Supple_B) ◽  
pp. 78-84
Author(s):  
Mackenzie A. Roof ◽  
James E. Feng ◽  
Afshin A. Anoushiravani ◽  
Lauren H. Schoof ◽  
Scott Friedlander ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Average Length ◽  
Care Center ◽  
Current Smoker ◽  
Quality Outcomes ◽  
Total Hip ◽  
Discharge Disposition ◽  
Point Of Entry ◽  
Increased Risk

Aims Previous studies have reported an increased risk for postoperative complications in the Medicaid population undergoing total hip arthroplasty (THA). These studies have not controlled for the surgeon’s practice or patient care setting. This study aims to evaluate whether patient point of entry and Medicaid status plays a role in quality outcomes and discharge disposition following THA. Methods The electronic medical record at our institution was retrospectively reviewed for all primary, unilateral THA between January 2016 and January 2018. THA recipients were categorized as either Medicaid or non-Medicaid patients based on a visit to our institution’s Hospital Ambulatory Care Center (HACC) within the six months prior to surgery. Only patients who had been operated on by surgeons (CML, JV, JDS, RS) with at least ten Medicaid and ten non-Medicaid patients were included in the study. The patients included in this study were 56.33% female, had a mean age of 60.85 years, and had a mean BMI of 29.14. The average length of follow-up was 343.73 days. Results A total of 426 hips in 403 patients were included in this study, with 114 Medicaid patients and 312 non-Medicaid patients. Medicaid patients had a significantly lower mean age (54.68 years (SD 12.33) vs 63.10 years (SD 12.38); p < 0.001), more likely to be black or ‘other’ race (27.19% vs 13.46% black; 26.32% vs 12.82% other; p < 0.001), and more likely to be a current smoker (19.30% vs 9.29%; p = 0.001). After adjusting for patient risk factors, there was a significant Medicaid effect on length of stay (LOS) (rate ratio 1.129, 95% confidence interval (CI) 1.048 to 1.216; p = 0.001) and facility discharge (odds ratio 2.010, 95% CI 1.398 to 2.890; p < 0.001). There was no Medicaid effect on surgical time (exponentiated β coefficient 1.015, 95% CI 0.995 to 1.036; p = 0.136). There was no difference in 30-day readmission, 90-day readmission, 30-day infections, 90-day infections, and 90-day mortality between the two groups. Conclusion After controlling for patient variables, there was a statistically significant Medicaid effect on LOS and facility discharge. These results indicate that clinically similar outcomes can be achieved for Medicaid patients; however, further work is needed on maximizing social support and preoperative patient education with a focus on successful home discharge. Cite this article: Bone Joint J 2020;102-B(7 Supple B):78–84.

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 PROSPECTIVE STUDY OF ASPIRIN FOR THROMBOEMBOLISM PROPHYLAXIS IN TOTAL HIP ARTHROPLASTY

2018 ◽  
Vol 26 (2) ◽  
pp. 86-90
Author(s):  
RAUL CARNEIRO LINS ◽  
EPITÁCIO LEITE ROLIM FILHO ◽  
FERNANDO DE SANTA CRUZ OLIVEIRA ◽  
SAULO MONTEIRO DOS SANTOS ◽  
TALE LUCAS VIEIRA ROLIM ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
High Risk ◽  
Total Hip Arthroplasty ◽  
Prospective Study ◽  
Hip Arthroplasty ◽  
Postoperative Bleeding ◽  
Thromboembolism Prophylaxis ◽  
Level Of Evidence ◽  
Total Hip ◽  
Post Procedure

ABSTRACT Objectives: To evaluate the effectiveness of aspirin as prophylaxis for deep venous thrombosis (DVT) in patients undergoing total hip arthroplasty (THA), and to analyze the incidence of bleeding during the post-operative period. Methods: This prospective study carried out in 2017 consisted of 37 patients indicated for THA with high risk for DVT. Immediately after the procedure, aspirin, elastic compression socks and early deambulation were initiated. Doppler ultrasound was performed in the legs 6 days and 6 weeks post-procedure to rule out venous thromboembolism. Hematometric variables and clinical criteria were used to detect bleeding. Results: The incidence of VTE (venous thromboembolism) 6 days post-procedure was 21.6%. By 6 weeks post-procedure, it dropped to 8.1%, (p = 0.102). Only 2.7% were diagnosed with VTE, 6 days and also 6 weeks post-procedure. Within the immediate postoperative period, hemoglobin was lower (p < 0.001), in contrast to 6 weeks after surgery, when it returned to baseline levels. Conclusion: Aspirin was an effective chemical prophylaxis for venous thromboembolism in high-risk patients who underwent THA. There was no clinical record of postoperative bleeding and hematometric levels suggested that there was no chronic bleeding. Level of Evidence II; Prospective study.

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