Reporting Surgical Site Infections Following Primary and Revision Hip Arthroplasty— One Size Does Not Fit All

2011 ◽  
Vol 32 (3) ◽  
pp. 296-297 ◽  
Author(s):  
LJ Worth ◽  
AL Bull ◽  
MJ Richards
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Risk Index ◽  
Surgical Site Infections ◽  
Revision Hip Arthroplasty ◽  
Total Hip ◽  
Clinical Phenomenon ◽  
Using Data ◽  
Healthcare Associated ◽  
Current Risk

The risk of surgical site infection (SSI) is greater after revision hip arthroplasty than after primary procedures. While this is accepted as a clinical phenomenon, standardized surveillance strategies for healthcare-associated infections, including SSIs, do not currently take this into consideration. Most notably, the National Nosocomial Infections Surveillance (NNIS) risk index for stratification does not differentiate between primary and revision surgeries. Using data from a single US center, Leekha et al. recently demonstrated that the risk for SSI was almost twice as high after revision total hip arthroplasty when compared to primary total hip arthroplasty and that risk was even greater when deep incisional or organ/space infections were analyzed. The objective of this study was to compare SSI rates following primary and revision hip arthroplasty in a much larger Australian population to determine whether differences are accounted for by current risk indexing.

Long-term results of tripolar constrained total hip arthroplasty in revision hip arthroplasty

2019 ◽  
Vol 101-B (6_Supple_B) ◽  
pp. 123-126 ◽  
Author(s):  
M. El-Husseiny ◽  
B. Masri ◽  
C. Duncan ◽  
D. S. Garbuz
Keyword(s):  
At Risk ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Recurrent Dislocation ◽  
Revision Hip Arthroplasty ◽  
Long Term Results ◽  
Total Hip ◽  
Patients At Risk ◽  
Patient At Risk

AimsWe investigated the long-term performance of the Tripolar Trident acetabular component used for recurrent dislocation in revision total hip arthroplasty. We assessed: 1) rate of re-dislocation; 2) incidence of complications requiring re-operation; and 3) Western Ontario and McMaster Universities osteoarthritis index (WOMAC) pain and functional scores.Patients and MethodsWe retrospectively identified 111 patients who had 113 revision tripolar constrained liners between 1994 and 2008. All patients had undergone revision hip arthroplasty before the constrained liner was used: 13 after the first revision, 17 after the second, 38 after the third, and 45 after more than three revisions. A total of 75 hips (73 patients) were treated with Tripolar liners due to recurrent instability with abductor deficiency, In addition, six patients had associated cerebral palsy, four had poliomyelitis, two had multiple sclerosis, two had spina bifida, two had spondyloepiphyseal dysplasia, one had previous reversal of an arthrodesis, and 21 had proximal femoral replacements. The mean age of patients at time of Tripolar insertions was 72 years (53 to 89); there were 69 female patients (two bilateral) and 42 male patients. All patients were followed up for a mean of 15 years (10 to 24). Overall, 55 patients (57 hips) died between April 2011 and February 2018, at a mean of 167 months (122 to 217) following their tripolar liner implantation. We extracted demographics, implant data, rate of dislocations, and incidence of other complications.ResultsAt ten years, the Kaplan–Meier survivorship for dislocation was 95.6% (95% confidence interval (CI) 90 to 98), with 101 patients at risk. At 20 years, the survivorship for dislocation was 90.6% (95% CI 81.0 to 95.5), with one patient at risk. Eight patients (7.2%) had a dislocation of their constrained liners. At ten years, the survival to any event was 89.4% (95% CI 82 to 93.8), with 96 patients at risk. At 20 years, the survival to any event was 82.5% (95% CI 71.9 to 89.3), with one patient at risk. Five hips (4.4%) had deep infection. Two patients (1.8%) developed dissociated constraining rings with pain but without dislocation, which required re-operation. Two patients (1.8%) had periprosthetic femoral fractures, without dislocation, that were treated by revision stems along with exchange of the well-functioning constrained liners.ConclusionConstrained tripolar liners used at revision hip arthroplasty provided favourable results in the long term for treatment of recurrent dislocation and for patients at high risk of dislocation. Cite this article: Bone Joint J 2019;101-B(6 Supple B):123–126.

The Current Role of Dual Mobility Articulations in Total Hip Arthroplasty

2018 ◽  
Vol 02 (04) ◽  
pp. 194-204
Author(s):  
Hari Parvataneni ◽  
Luis Pulido ◽  
Hernan Prieto ◽  
Arnold Silverberg
Keyword(s):  
High Risk ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Clinical Success ◽  
The United States ◽  
Revision Hip Arthroplasty ◽  
Dual Mobility ◽  
Total Hip ◽  
Hip Stability

AbstractThe concept of dual mobility (DM) bearings in total hip arthroplasty was first introduced by Professors Gilles Bousquet and Andre Rambert in France in 1974 with the goal of enhancing hip stability. Although DM did not receive U.S. Food and Drug Administration approval for commercial use in the United States until 2009, there has been a surge in popularity of DM implants over the past several years, evidenced by the American Joint Replacement Registry data. The enthusiasm for DM stems from a growing body of literature that supports its use across a range of patient populations, most notably revision hip arthroplasty and high-risk primary scenarios. DM has been shown to effectively reduce the risk of dislocation while also exhibiting excellent survivorship. DM does incur some unique risks, namely, intraprosthetic dissociation, but many of the early concerns with DM have not been realized in the literature and do not seem to negatively impact its long-term survivorship. The exact indications for DM have yet to be defined and remain a matter of debate. It should be considered as an alternative for any primary or revision hip arthroplasty at high risk for postoperative instability. In this article, the authors review the current literature regarding the clinical success of DM implants for a variety of indications, all of which predispose to hip instability. The history, basic biomechanics, modern designs, and unique complications are also discussed.

Should National Standards for Reporting Surgical Site Infections Distinguish between Primary and Revision Orthopedic Surgeries?

2010 ◽  
Vol 31 (05) ◽  
pp. 503-508 ◽  
Author(s):  
Surbhi Leekha ◽  
Priya Sampathkumar ◽  
Daniel J. Berry ◽  
Rodney L. Thompson
Keyword(s):  
Total Hip Arthroplasty ◽  
Confidence Interval ◽  
Hip Arthroplasty ◽  
Odds Ratio ◽  
Risk Index ◽  
National Standards ◽  
Revision Total Hip Arthroplasty ◽  
Total Hip ◽  
Hip Arthroplasties ◽  
Primary Total Hip Arthroplasty

Objective. To compare the surgical site infection (SSI) rate after primary total hip arthroplasty with the SSI rate after revision total hip arthroplasty. Design. Retrospective cohort study. Setting. Mayo Clinic in Rochester, Minnesota, a referral orthopedic center. Patients. All patients undergoing primary total hip arthroplasty or revision total hip arthroplasty during the period from January 1, 2002, through December 31, 2006. Methods. We obtained data on total hip arthroplasties from a prospectively maintained institutional surgical database. We reviewed data on SSIs collected prospectively as part of routine infection control surveillance, using the criteria of the Centers for Disease Control and Prevention for the definition of an SSI. We used logistic regression analyses to evaluate differences between the SSI rate after primary total hip arthroplasty and the SSI rate after revision total hip arthroplasty. Results. A total of 5,696 total hip arthroplasties (with type 1 wound classification) were analyzed, of which 1,381 (24%) were revisions. A total of 61 SSIs occurred, resulting in an overall SSI rate of 1.1% for all total hip arthroplasties. When stratified by the National Nosocomial Infection Surveillance (NNIS) risk index, SSI rates were 0.5%, 1.2%, and 1.6% in risk categories 0, 1, and 2, respectively. After controlling for the NNIS risk index, the risk of SSI after revision total hip arthroplasty was twice as high as that after primary total hip arthroplasty (odds ratio, 2.2 [95% confidence interval, 1.3-3.7]). In the analysis restricted to the development of deep incisional or organ space infections, the risk of SSI after revision total hip arthroplasty was nearly 4 times that after primary total hip arthroplasty (odds ratio, 3.9 [95% confidence interval, 2.0-7.6]). Conclusion. Including revision surgeries in the calculation of SSI rates can result in higher infection rates for institutions that perform a larger number of revisions. Taking NNIS risk indices into account does not eliminate this effect. Differences between primary and revision surgeries should be considered in national standards for the reporting of SSIs.

Incidence, Causes, and Timing of 30-Day Readmission following Total Hip Arthroplasty

2019 ◽  
Vol 03 (03) ◽  
pp. 118-123
Author(s):  
Gannon L. Curtis ◽  
Michael Jawad ◽  
Linsen T. Samuel ◽  
Carlos A. Higuera-Rueda ◽  
Bryan E. Little ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Linear Regression Analysis ◽  
Surgical Site Infections ◽  
Cardiovascular Complications ◽  
Wound Complications ◽  
Improvement Program ◽  
Gastrointestinal Complications ◽  
Total Hip ◽  
Common Causes

AbstractUnplanned readmissions are associated with increased financial burdens. It is important to understand why they occur and how to reduce them. This study identifies incidences, trends, causes, and timing of 30-day readmissions after total hip arthroplasty (THA). Primary THA cases from 2012 to 2016 in the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database were identified (n = 122,451). Fractures (n = 3,990), nonelective surgery (n = 1,715), and bilateral THA (n = 730) were excluded, leaving 116,016 cases. Linear regression analysis determined readmission trends overtime. The readmission rate after THA from 2012 to 16 was 3.32%, which significantly decreased during this time (p = 0.022). The top five causes of readmission included musculoskeletal complications (14.8%), deep surgical site infections (SSI; 11.1%), non-SSI infections (10.8%), gastrointestinal complications (GI; 7.5%), and cardiovascular complications (CV; 7.0%). The most common cause of readmission during week 1 was non-SSI infections (13.0%), week 2 was musculoskeletal complications (16%), week 3 was deep SSI (18.4%), and week 4 was deep SSI (18.6%). Causes of readmission that significantly decreased (p < 0.05) from week 1 to 4 include CV complications, GI complications, non-SSI infections, pain, and respiratory complications. In contrast, causes that significantly increased during this time included deep SSI, prosthesis complications, superficial SSI, and wound complications. Readmissions following THA significantly declined from 2012 to 2016. The most common causes of readmission were musculoskeletal complications, deep SSI, non-SSI infections, GI complications, and CV complications. Interestingly, the most common causes of readmission changed from week to week. These findings may help to develop policies to prevent readmissions following THA.

The Impact of Anesthetic Management on Surgical Site Infections in Patients Undergoing Total Knee or Total Hip Arthroplasty

2015 ◽  
Vol 121 (5) ◽  
pp. 1215-1221 ◽  
Author(s):  
Sandra L. Kopp ◽  
Elie F. Berbari ◽  
Douglas R. Osmon ◽  
Darrell R. Schroeder ◽  
James R. Hebl ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Anesthetic Management ◽  
Surgical Site Infections ◽  
Total Hip ◽  
Total Knee ◽  
The Impact

scholarly journals The short-term outcome of hip revision arthroplasty with Trabecular Metal™ components and augments

2020 ◽  
Vol 19 (3) ◽  
Author(s):  
L Noconjo ◽  
MB Nortje
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Revision Arthroplasty ◽  
Revision Hip Arthroplasty ◽  
Trabecular Metal ◽  
Short Term ◽  
Level Of Evidence ◽  
Term Outcome ◽  
Hip Revision ◽  
Total Hip

ABSTRACT BACKGROUND: Highly porous Trabecular Metal™ acetabular components are increasingly being used in revision hip arthroplasty as they facilitate ingrowth, provide a useful mechanism to deal with bone loss and may decrease the risk of infection. The purpose of this audit was to describe: 1) the total number of hip arthroplasty surgeries over Ave years, the ratio of revision to primary hip arthroplasty and indications for revision; 2) the short-term outcomes of revision hip arthroplasty with Trabecular Metal™ components and augments METHODS: A retrospective folder and radiograph review of all patients who had revision total hip arthroplasty (THA) at a tertiary level hospital from February 2012 to February 2017 was done RESULTS: There were 979 THAs performed over the period - 863 (87%) primary THAs, and 116 (12%) hip revision cases performed in 107 patients. Of the 116 (107 patients) hip revisions, there were seven (6%) re-revisions in Ave patients. The indications for revision were aseptic loosening 67 (59%), septic loosening 11 (10%), liner wear 18 (16%), periprosthetic fracture Ave (4%), other 15 (13%). Trabecular Metal™ was used for revision in 16 hips (14 patients), which is 14% of the total 116 revisions. There were ten females and four males with an average age of 61 years. The average duration of follow-up in this group was 18.5 months (1.5-39.2). In these 16 Trabecular Metal™ hips, there were three (19%) early failures of fixation due to technical errors CONCLUSION: In our institution, 12% of the arthroplasty is revision surgery. The indications for revision are similar to published literature. Trabecular Metal™ revisions had a 19% early failure rate due to technical error Level of evidence: Level 4 Keywords: Trabecular Metal™, augments, total hip arthroplasty, revision hip arthroplasty

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