Routine Post-operative Radiographs Following Hip Hemiarthroplasty: Is It a Necessity?

Abstract Purpose Hip hemiarthroplasty (HA) is a commonly performed operation. A post-operative radiograph forms part of the routine hip fracture pathway, although patients are often mobilised prior to this investigation. This study seeks to provide evidence for a pragmatic clinical change to optimise patient safety and allocate limited resources within the National Health Service (NHS). Methods We undertook a retrospective database review of 1563 HA procedures to assess whether the routine ordering of check radiographs played an important role in a patient’s post-operative care. Results 18 (1.2%) mechanical complications led to a return to theatre within 6 weeks of the index procedure. All were dislocations. Ten had a normal post-operative radiograph and five had documented suspicion of dislocation prior to radiography. The post-operative check radiograph was the sole identifier of dislocation in only three patients (0.2%). All three of these patients were pre-morbidly bed bound and non-communicative due to cognitive impairment (AMTS 0/10). Conclusion Unless a patient is pre-morbidly bed bound and cognitively impaired, routine post-operative radiography following HA surgery is of little clinical benefit, yet may carry considerable risk to the patient and cost to the NHS. A pragmatic compromise is to perform intra-operative fluoroscopic imaging.

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Periprosthetic Joint Infection Prophylaxis in the Elderly after Hip Hemiarthroplasty in Proximal Femur Fractures: Insights and Challenges

Antibiotics ◽

10.3390/antibiotics10040429 ◽

2021 ◽

Vol 10 (4) ◽

pp. 429

Author(s):

Dolors Rodríguez-Pardo ◽

Laura Escolà-Vergé ◽

Júlia Sellarès-Nadal ◽

Pablo S. Corona ◽

Benito Almirante ◽

...

Keyword(s):

Periprosthetic Joint Infection ◽

Antimicrobial Prophylaxis ◽

Joint Infection ◽

Asymptomatic Bacteriuria ◽

Infection Prophylaxis ◽

Beta Lactam ◽

Hip Hemiarthroplasty ◽

Femur Fractures ◽

Published Evidence ◽

Prophylactic Measures

We review antibiotic and other prophylactic measures to prevent periprosthetic joint infection (PJI) after hip hemiarthroplasty (HHA) surgery in proximal femoral fractures (PFFs). In the absence of specific guidelines, those applied to these individuals are general prophylaxis guidelines. Cefazolin is the most widely used agent and is replaced by clindamycin or a glycopeptide in beta-lactam allergies. A personalized antibiotic scheme may be considered when colonization by a multidrug-resistant microorganism (MDRO) is suspected. Particularly in methicillin-resistant Staphylococcus aureus (MRSA) colonization or a high prevalence of MRSA-caused PJIs a glycopeptide with cefazolin is recommended. Strategies such as cutaneous decolonization of MDROs, mainly MRSA, or preoperative asymptomatic bacteriuria treatment have also been addressed with debatable results. Some areas of research are early detection protocols in MDRO colonizations by polymerase-chain-reaction (PCR), the use of alternative antimicrobial prophylaxis, and antibiotic-impregnated bone cement in HHA. Given that published evidence addressing PJI prophylactic strategies in PFFs requiring HHA is scarce, PJIs can be reduced by combining different prevention strategies after identifying individuals who will benefit from personalized prophylaxis.

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ESR and CRP Diagnostic Thresholds for Prosthetic Joint Infection in Hip Hemiarthroplasty

The Journal of Hip Surgery ◽

10.1055/s-0040-1719115 ◽

2020 ◽

Vol 4 (04) ◽

pp. 187-192

Author(s):

Jared A. Warren ◽

Oliver Scotting ◽

Hiba K. Anis ◽

James Bircher ◽

Alison K. Klika ◽

...

Keyword(s):

Prosthetic Joint Infection ◽

Joint Infection ◽

Area Under The Curve ◽

Roc Curves ◽

Musculoskeletal Infection ◽

Hip Hemiarthroplasty ◽

Diagnostic Thresholds ◽

Diagnostic Threshold ◽

Prosthetic Joint ◽

The Mean

AbstractDiagnostic thresholds used to standardize the definition for prosthetic joint infection (PJI) have largely focused on total joint arthroplasty (TJA). Established PJI thresholds exist for serum erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) in TJA; however, they do not exist for revision hip hemiarthroplasty (rHHA). The purpose of this study was to establish thresholds for (1) ESR and (2) CRP to diagnose PJI in rHHA. Data were collected on a prospective cohort of 69 rHHA patients undergoing orthopaedic surgery between 1/2017 and 2/2019 in a single health care system. Procedures were categorized as septic or aseptic revisions using Musculoskeletal Infection Society (MSIS) criteria (2013). There were 44 ESRs (n = 28 aseptic, n = 16 septic) and 46 CRPs (n = 29 aseptic, n = 17 septic) available for analysis. Two tailed t-tests were performed to compare the mean ESR and CRP in aseptic and septic cases. Receiver operator characteristic (ROC) curves were generated to obtain diagnostic cutoff thresholds using the Youden's Index (J) for ESR and CRP. The mean ESR was 50.3 ± 30.6 mm/h versus 15.4 ± 17.7 mm/h (p < 0.001), while the mean CRP was 29.9 ± 24.8 mg/L versus 4.1 ± 8.2 mg/L (p < 0.001) for septic and aseptic revisions, respectively. The diagnostic threshold for PJI determined by the ROC curve was 44 mm/h for ESR (sensitivity = 56.3%; specificity = 100.0%; J = 0.563; area under the curve (AUC) = 0.845), while it was 12.5 mg/L for CRP (sensitivity = 70.6%; specificity = 96.6%; J = 0.672; AUC = 0.896). For patients with HHA, an ESR of 44 mm/h was and a CRP of 12.5 mg/L was highly specific for PJI. The thresholds are similar to the MSIS thresholds currently published. Larger prospective trials are needed to establish more robust and conclusive diagnostic criteria for PJI in HHA, including investigations not only of ESR and CRP but synovial white blood cell count and synovial polymorphonuclear leukocytes % as well.

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Serum Zinc as a Prognostic Tool for Wound Healing in Hip Hemiarthroplasty

Clinical Orthopaedics and Related Research ◽

10.1097/00003086-200403000-00043 ◽

2004 ◽

Vol 420 ◽

pp. 304-308 ◽

Cited By ~ 15

Author(s):

Pedro Zorrilla ◽

Jos?? A Salido ◽

Antonio L??pez-Alonso ◽

Agust??n Silva

Keyword(s):

Wound Healing ◽

Serum Zinc ◽

Hip Hemiarthroplasty ◽

Prognostic Tool

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The effect of high dose antibiotic impregnated cement on rate of surgical site infection after hip hemiarthroplasty for fractured neck of femur: a protocol for a double-blind quasi randomised controlled trial

BMC Musculoskeletal Disorders ◽

10.1186/1471-2474-14-356 ◽

2013 ◽

Vol 14 (1) ◽

Cited By ~ 7

Author(s):

Andrew P Sprowson ◽

Cyrus D Jensen ◽

Sanjay Gupta ◽

Nick Parsons ◽

Aradhyula N Murty ◽

...

Keyword(s):

Randomised Controlled Trial ◽

Surgical Site Infection ◽

Controlled Trial ◽

High Dose ◽

Site Infection ◽

Fractured Neck Of Femur ◽

Double Blind ◽

Neck Of Femur ◽

Hip Hemiarthroplasty ◽

Randomised Controlled

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2021 Frank Stinchfield Award: A novel cemented hip hemiarthroplasty infection model with real-time in vivo imaging in rats

The Bone & Joint Journal ◽

10.1302/0301-620x.103b7.bjj-2020-2435.r1 ◽

2021 ◽

Vol 103-B (7 Supple B) ◽

pp. 9-16

Author(s):

William J. Hadden ◽

Mazen Ibrahim ◽

Mariam Taha ◽

Kerstin Ure ◽

Yun Liu ◽

...

Keyword(s):

Real Time ◽

In Vivo Imaging ◽

Biofilm Formation ◽

Joint Infection ◽

Volumetric Analysis ◽

In Vivo Model ◽

Infection Model ◽

Sprague Dawley ◽

Hip Hemiarthroplasty

Aims The aims of this study were to develop an in vivo model of periprosthetic joint infection (PJI) in cemented hip hemiarthroplasty, and to monitor infection and biofilm formation in real-time. Methods Sprague-Dawley rats underwent cemented hip hemiarthroplasty via the posterior approach with pre- and postoperative gait assessments. Infection with Staphylococcus aureus Xen36 was monitored with in vivo photoluminescent imaging in real-time. Pre- and postoperative gait analyses were performed and compared. Postmortem micro (m) CT was used to assess implant integration; field emission scanning electron microscopy (FE-SEM) was used to assess biofilm formation on prosthetic surfaces. Results All animals tolerated surgery well, with preservation of gait mechanics and weightbearing in control individuals. Postoperative in vivo imaging demonstrated predictable evolution of infection with logarithmic signal decay coinciding with abscess formation. Postmortem mCT qualitative volumetric analysis showed high contact area and both cement-bone and cement-implant interdigitation. FE-SEM revealed biofilm formation on the prosthetic head. Conclusion This study demonstrates the utility of a new, high-fidelity model of in vivo PJI using cemented hip hemiarthroplasty in rats. Inoculation with bioluminescent bacteria allows for non-invasive, real-time monitoring of infection. Cite this article: Bone Joint J 2021;103-B(7 Supple B):9–16.

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