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Suratwala S, Kommareddy D, Duvvuri P, Woltmann J, Segal A, Krauss E. Cost-effectiveness and clinical utility of universal pre-admission MRSA screening in total joint arthroplasty patients. J Hosp Infect 2023; 138:27-33. [PMID: 37277014 DOI: 10.1016/j.jhin.2023.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 04/26/2023] [Accepted: 05/01/2023] [Indexed: 06/07/2023]
Abstract
BACKGROUND For patients undergoing total joint arthroplasty (TJA), pre-admission meticillin-resistant Staphylococcus aureus (MRSA) nasal screening has been widely adopted to prevent postoperative joint infection. However, screening cost-effectiveness and clinical utility have not been adequately evaluated. AIM To assess the MRSA infection rate, associated costs, and costs of screening at our institution, before and after screening implementation. METHODS This was a retrospective cohort study examining patients who underwent TJA at a health system in New York State, between 2005 and 2016. Patients were divided into the 'no-screening' group if the operation occurred prior to adoption of the MRSA screening protocol in 2011 and the 'screening' group if afterwards. The number of MRSA joint infections, cost of each infection, and costs associated with preoperative screening were recorded. Fisher's exact test and cost comparison analysis were performed. FINDINGS The no-screening group had four MRSA infections in 6088 patients over a seven-year period, whereas the screening group had two in 5177 patients over five years. Fisher's exact test showed no significant association between screening and MRSA infection rate (P = 0.694). The cost of postoperative MRSA joint infection treatment was US$40,919.13 per patient, whereas annual nasal screening was US$103,999.97. CONCLUSION At our institution, MRSA screening had little impact on infection rates and led to increased costs, with 2.5 MRSA infections required annually to meet the costs of screening. Therefore, the screening protocol may be best suited for high-risk populations, rather than the average TJA patient. The authors recommend a similar clinical utility and cost-effectiveness analysis at other institutions implementing MRSA screening programmes.
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Affiliation(s)
- S Suratwala
- Center for Orthopaedic Excellence at Syosset Hospital, Syosset, NY, USA
| | - D Kommareddy
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - P Duvvuri
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.
| | - J Woltmann
- Center for Orthopaedic Excellence at Syosset Hospital, Syosset, NY, USA
| | - A Segal
- Center for Orthopaedic Excellence at Syosset Hospital, Syosset, NY, USA
| | - E Krauss
- Center for Orthopaedic Excellence at Syosset Hospital, Syosset, NY, USA
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Harper KD, Park KJ, Brozovich A, Sullivan TC, Serpelloni S, Taraballi F, Incavo SJ, Clyburn TA. Intraosseous Vancomycin in Total Hip Arthroplasty - Superior Tissue Concentrations and Improved Efficiency. J Arthroplasty 2023:S0883-5403(23)00385-6. [PMID: 37088221 DOI: 10.1016/j.arth.2023.04.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 04/13/2023] [Accepted: 04/14/2023] [Indexed: 04/25/2023] Open
Abstract
BACKGROUND Literature shows that intraosseous (IO) infusions are capable of providing increased local concentrations compared to those administered via intravenous (IV) access. Successes while using the technique for antibiotic prophylaxis administration in total knee arthroplasty (TKA) prompted consideration for use in total hip arthroplasty (THA) however; no study exists for the use of IO vancomycin in THA. METHODS This single-blinded randomized control trial was performed from December 2020 to May 2022. Twenty patients were randomized into one of two groups: IV vancomycin (15 mg/kg) given routinely, or IO vancomycin (500mg/100cc of NS) injected into the greater trochanter during incision. Serum vancomycin levels were collected at incision and closure. Soft tissue vancomycin levels were taken from the gluteus maximus (at start and end of case), and acetabular pulvinar tissue. Bone vancomycin levels were taken from the femoral head, acetabular reamings, and intramedullary bone. Adverse local/systemic reactions, 30-day and 90-day complications were also tracked. RESULTS A statistically significant reduction in serum vancomycin levels was seen when comparing IO to IV vancomycin at both the start and end of the procedure. All local tissue samples had higher concentrations of vancomycin in the IO group. Statistically significant increases were present within the acetabular bone reamings, and approached significance in intramedullary femoral bone. CONCLUSION This study demonstrates the utility of IO vancomycin in primary THA with increased local tissue and decreased systemic concentrations. With positive findings in an area without tourniquet use, IO may be considered for antibiotic delivery for alternative procedures.
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Affiliation(s)
- Katharine D Harper
- Department of Orthopedic Surgery, Washington DC VA Medical Center, Washington, DC.
| | - Kwan J Park
- Houston Methodist Orthopedics and Sports Medicine, Houston, TX
| | - Ava Brozovich
- Houston Methodist Orthopedics and Sports Medicine, Houston, TX; Center for Musculoskeletal Regeneration, Houston Methodist Research Institute, Houston, TX
| | | | - Stefano Serpelloni
- Center for Musculoskeletal Regeneration, Houston Methodist Research Institute, Houston, TX
| | - Francesca Taraballi
- Center for Musculoskeletal Regeneration, Houston Methodist Research Institute, Houston, TX
| | | | - Terry A Clyburn
- Houston Methodist Orthopedics and Sports Medicine, Houston, TX
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Candidal Prosthetic Hip Infection in a Patient with Previous Candidal Sepsis - A Case Report. J UOEH 2021; 42:327-330. [PMID: 33268609 DOI: 10.7888/juoeh.42.327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
A 60 year-old woman with hip dysplasia battled with duodenal cancer that was complicated with Candida tropicalis sepsis. Two years later, the patient underwent a total hip arthroplasty (THA). She complained of a persisting low-grade fever and local heat on the THA scar. Arthrocentesis of the hip was performed and the Candida tropicalis was detected. Debridement and polyethylene liner/modular head exchange were performed 28 days after the primary THA. Fluconazole was administrated for one year. The patient reported no symptoms five years later. It was found that periprosthetic infection could be prevented by implant preservation surgery.
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Su WC, Lai YC, Lee CH, Shih CM, Chen CP, Hung LL, Wang SP. The Prevention of Periprosthetic Joint Infection in Primary Total Hip Arthroplasty Using Pre-Operative Chlorhexidine Bathing. J Clin Med 2021; 10:jcm10030434. [PMID: 33498636 PMCID: PMC7865798 DOI: 10.3390/jcm10030434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 01/13/2021] [Accepted: 01/20/2021] [Indexed: 11/26/2022] Open
Abstract
Periprosthetic joint infection (PJI) after total hip arthroplasty (THA) is a devastating complication. The aim of this study was to investigate whether preoperative bathing using chlorhexidine gluconate (CHG) before THA can effectively reduce the postoperative PJI rate. A total of 933 primary THA patients, with the majority being female (54.4%) were included in the study. Primary THA patients who performed preoperative chlorhexidine bathing were assigned to the CHG group (190 subjects), and those who did not have preoperative chlorhexidine bathing were in the control group (743 subjects). The effects of chlorhexidine bathing on the prevention of PJI incidence rates were investigated. Differences in age, sex, and the operated side between the two groups were not statistically significant. Postoperative PJI occurred in four subjects, indicating an infection rate of 0.43% (4/933). All four infected subjects belonged to the control group. Although the PJI cases were significantly more in the control group than in the CHG group, statistical analysis revealed no statistical significance in the risk of PJI occurrence between the two groups (p = 0.588). Preoperative skin preparation by bathing with a 2% chlorhexidine gluconate cleanser did not produce significant effects on the prevention of postoperative PJI in primary THA.
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Affiliation(s)
- Wen-Chi Su
- Department of Nursing, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (W.-C.S.); (Y.-C.L.); (L.-L.H.)
| | - Yu-Chin Lai
- Department of Nursing, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (W.-C.S.); (Y.-C.L.); (L.-L.H.)
| | - Cheng-Hung Lee
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (C.-H.L.); (C.-M.S.); (C.-P.C.)
- Department of Food Science and Technology, HungKuang University, Taichung 43302, Taiwan
| | - Cheng-Min Shih
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (C.-H.L.); (C.-M.S.); (C.-P.C.)
- Department of Physical Therapy, HungKuang University, Taichung 43302, Taiwan
- Department of Biological Science and Technology, National Chiao Tung University, Hsinchu 30010, Taiwan
| | - Chao-Ping Chen
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (C.-H.L.); (C.-M.S.); (C.-P.C.)
- Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli County 35664, Taiwan
| | - Li-Ling Hung
- Department of Nursing, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (W.-C.S.); (Y.-C.L.); (L.-L.H.)
- Department of Nursing, HungKuang University, Taichung 43302, Taiwan
| | - Shun-Ping Wang
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (C.-H.L.); (C.-M.S.); (C.-P.C.)
- Sports Recreation and Health Management Continuing Studies-Bachelor’s Degree Completion Program, Tunghai University, Taichung 40704, Taiwan
- Correspondence:
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Kawakami S, Iwata K, Shimamura M, Mashiba T, Yokota K, Negayama K, Ohkusu K, Yamamoto T. Prosthetic joint infection after total hip arthroplasty caused by Sneathia sanguinegens: A case report (CARE-complaint). Medicine (Baltimore) 2020; 99:e22494. [PMID: 33031285 PMCID: PMC7544305 DOI: 10.1097/md.0000000000022494] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 08/18/2020] [Accepted: 09/01/2020] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Sneathia sanguinegens(S sanguinegens) is a gram-negative rod-shaped bacterium mostly reported to cause a perinatal infection, and there are no reports of S sanguinegens in prosthetic joint infection (PJI). The purpose of this report is to describe a very rare case of PJI after total hip arthroplasty (THA) caused by S sanguinegens. PATIENT CONCERNS A 79-year-old woman presented with right coxalgia, inability to walk, and a fever of 39°C. She had undergone THA 28 years earlier for osteoarthritis of the hip. DIAGNOSES The diagnosis was acute late-onset PJI, because blood tests revealed marked inflammatory reaction and computed tomography showed an abscess at the right hip joint; synovial fluid analysis resulted in detection of a gram-negative bacillus. INTERVENTION Surgical debridement with retention of the implant and antibiotic therapy was performed. OUTCOMES One month after surgery, polymerase chain reaction (PCR) assay showed that the pathogen was 99.9% likely to be S sanguinegens. There has been no recurrence of infection or loosening of the implant in the 2 years since her surgery. LESSONS PCR should facilitate detection of previously unknown pathogens and potentially novel bacterial species.
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Affiliation(s)
- Shohei Kawakami
- Department of Orthopedic Surgery, Faculty of Medicine, Kagawa University, Miki-cho, Kita-gun
| | - Ken Iwata
- Department of Orthopedic Surgery, Faculty of Medicine, Kagawa University, Miki-cho, Kita-gun
| | - Masashi Shimamura
- Department of Orthopedic Surgery, Faculty of Medicine, Kagawa University, Miki-cho, Kita-gun
| | - Tasuku Mashiba
- Department of Orthopedic Surgery, Faculty of Medicine, Kagawa University, Miki-cho, Kita-gun
| | - Kyoko Yokota
- Department of Internal Medicine, Kagawa Prefectural Central Hospital, Takamatsu City
| | - Kiyoshi Negayama
- Department of Infectious Diseases, Kagawa University Hospital, Miki-cho, Kita-gun, Kagawa
| | - Kiyofumi Ohkusu
- Department of Microbiology, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
| | - Tetsuji Yamamoto
- Department of Orthopedic Surgery, Faculty of Medicine, Kagawa University, Miki-cho, Kita-gun
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Taylor-Williams O, Nossent J, Inderjeeth CA. Incidence and Complication Rates for Total Hip Arthroplasty in Rheumatoid Arthritis: A Systematic Review and Meta-Analysis Across Four Decades. Rheumatol Ther 2020; 7:685-702. [PMID: 33000421 PMCID: PMC7695804 DOI: 10.1007/s40744-020-00238-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 09/19/2020] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Over the past several decades, management of rheumatoid arthritis (RA) has evolved significantly, but few studies have examined the real-world impact of these changes on orthopaedic surgery in patients with RA. This systematic review assessed total hip arthroplasty (THA) incidence and postoperative complication rates across the past four decades. METHODS This is a systematic literature review sourcing data on THA in patients with RA from the electronic databases MEDLINE, EMBASE, Scopus, and Cochrane between January 1, 1980 and December 31, 2019. RESULTS The search retrieved 1715 articles of which 44 were included for quantitative synthesis. The rate for THA decreased by almost 40% from 11/1000 patient years (PY) in the 2000s to 7/1000 PY in the 2010s, while the overall complication rate decreased from 9.9% in the 1990s to 5.3% in the 2010s. Throughout the duration of the study, THA incidence and overall complication rate decreased. However, not all individual complication rates decreased. For example, revision and periprosthetic fracture decreased, infection and aseptic loosening remained constant, and dislocation increased. CONCLUSION Medical management of patients with RA has reduced the need for THA, while postoperative medical and surgical management has improved some postoperative outcomes. Nevertheless, there remains room for further improvement to postoperative outcomes through RA-specific management.
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Affiliation(s)
| | - Johannes Nossent
- School of Medicine, The University of Western Australia, Perth, Australia.
- Sir Charles Gairdner and Osborne Park Health Care Group, Perth, Australia.
| | - Charles A Inderjeeth
- School of Medicine, The University of Western Australia, Perth, Australia.
- Sir Charles Gairdner and Osborne Park Health Care Group, Perth, Australia.
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Lin CA, Behrens PH, Paiement G, Hardy WD, Mirocha J, Rettig RL, Kiziah HL, Rudikoff AG, Hernandez Conte A. Metabolic factors and post-traumatic arthritis may influence the increased rate of surgical site infection in patients with human immunodeficiency virus following total hip arthroplasty. J Orthop Surg Res 2020; 15:316. [PMID: 32787972 PMCID: PMC7425402 DOI: 10.1186/s13018-020-01827-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 07/29/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The impact of CD4+ T-cell count and highly active antiretroviral therapy (HAART) on the rate of surgical site infection (SSI) in patients with human immunodeficiency virus (HIV) undergoing total hip arthroplasty is still unclear. The goals of this study were to assess the rate of perioperative infection at a large tertiary care referral center and to identify risk factors in HIV+ patients undergoing total hip arthroplasty (THA). METHODS This study was a prospective, observational study at a single medical center from 2000-2017. Patients who were HIV+ and underwent THA were followed from the preoperative assessment period, through surgery and for a 2-year follow-up period. RESULTS Sixteen of 144 HIV+ patients (11%) undergoing THA developed perioperative surgical site infections. Fourteen patients (10%) required revision THA within a range of 12 to 97 days after the initial surgery. The patients' mean age was 49.6 ± 4.5 years, and the most common diagnosis prompting THA was osteonecrosis (96%). Patients who developed SSI had a lower waist-hip ratio (0.86 vs. 0.93, p = 0.047), lower high density lipoprotein cholesterol (45.8 vs. 52.5, p = 0.015) and were more likely to have post-traumatic arthritis (12.5% vs. 0%, p = 0.008). Logistic regression analysis demonstrated that current alcohol use and higher waist-hip ratio were significant protectors against infection (p < 0.05). No other demographic, medical, immunologic parameters, or specific HAART regimens were associated with perioperative infection. CONCLUSIONS Immunologic status as measured by CD4+ cell count, HIV viral load, and medical therapy do not appear to influence the development of SSI in HIV+ patients undergoing THA. Metabolic factors and post-traumatic arthritis may influence the increased rate of infection in HIV+ patients following THA.
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Affiliation(s)
- Carol A Lin
- Department of Orthopedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Phillip H Behrens
- Department of Orthopedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Guy Paiement
- Department of Orthopedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - W David Hardy
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - James Mirocha
- Division of Biostatistics & Bioinformatics, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Robert L Rettig
- Department of Surgery, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA
| | - Heidi L Kiziah
- Department of Anesthesiology, Kaiser Permanente Los Angeles Medical Center, 4867 Sunset Blvd, 3rd Floor, Suite 3017, Los Angeles, CA, 90027, USA
| | - Andrew G Rudikoff
- Department of Anesthesiology, Kaiser Permanente Los Angeles Medical Center, 4867 Sunset Blvd, 3rd Floor, Suite 3017, Los Angeles, CA, 90027, USA
| | - Antonio Hernandez Conte
- Department of Anesthesiology, Kaiser Permanente Los Angeles Medical Center, 4867 Sunset Blvd, 3rd Floor, Suite 3017, Los Angeles, CA, 90027, USA.
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One-stage revision of an infected cementless total hip replacement. Vet Comp Orthop Traumatol 2016; 29:541-546. [PMID: 27761578 DOI: 10.3415/vcot-16-01-0004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 07/26/2016] [Indexed: 11/17/2022]
Abstract
A two-year-old, 44 kg dog with a right Helica cementless total hip replacement (THR) was radiographically diagnosed with implant loosening eight months after the index total hip replacement procedure. Subsequent synoviocentesis and synovial fluid culture revealed a methicillin-resistant coagulase-negative Staphylococcus spp infection of the right THR. A one-stage revision using a hybrid BFX cementless acetabular cup and CFX cemented femoral stem was performed. Vancomycin and micro-silver antimicrobial powder impregnated cement were used in the revision. At re-evaluation 27 months following the revision procedure, the patient did not exhibit any signs of lameness. Radiographic images confirmed stable implants, with bone ingrowth into the cup and no signs of implant loosening. Our report demonstrates the success of a one-stage THR revision when faced with a multi-drug resistant periprosthetic infection, when combined with the use of micro-silver antimicrobial powder and culture-based antibiotic impregnated cement therapy.
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Monitoring the quality of robot-assisted pedicle screw fixation in the lumbar spine by using a cumulative summation test. Spine (Phila Pa 1976) 2015; 40:87-94. [PMID: 25575085 DOI: 10.1097/brs.0000000000000680] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Prospective randomized controlled trial. OBJECTIVE The aim of this study was to monitor the quality control of robot-assisted pedicle screw fixation accuracy by using a cumulative summation (CUSUM) test at the initial stage of its application. SUMMARY OF BACKGROUND DATA Although robot-assisted pedicle screw fixation reduces screw misplacement rates and provides critical support for minimally invasive surgical procedures, there have been no reports relating to the monitoring of quality control of the accuracy of this robot-assisted pedicle screw fixation procedure. METHODS Patients with lumbar spinal stenosis scheduled to undergo surgery were randomly and equally assigned through 1:1 allocation to a robot-assisted minimally invasive posterior lumbar interbody fusion (Rom-PLIF) group or a conventional open posterior PLIF using freehand technique group. The accuracy of pedicle screw placement was evaluated using postoperative computed tomography. The primary outcome was the CUSUM analysis for monitoring the quality control of the accuracy of pedicle screw insertion between the Rom-PLIF and conventional open posterior PLIF using freehand technique groups. RESULTS Of the 80 pedicle screws inserted in each group, 4 screws in the Rom-PLIF group, and 7 in the conventional open PLIF group, breached the pedicle. Of these 11 offending screws, 4 cases were categorized as grade B in the Rom-PLIF group, whereas 6 were grade B and 1 case was grade C in the Com-PLIF group, using the Gertzbein and Robbins classification. Throughout the monitoring period, there was no CUSUM test-derived indication that the quality of performance of the pedicle screw fixation procedure was inadequate in either group. CONCLUSION First, this study demonstrates the adequacy of quality control of robot-assisted pedicle screw fixation even early in the application period based on the CUSUM analysis. Second, the CUSUM test can be a useful tool for monitoring of the quality of procedures related with spine surgery.
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Watson BS, Jenkins PJ, Ballantyne JA. The natural history of unexplained early poor function following total hip replacement. INTERNATIONAL ORTHOPAEDICS 2013; 38:33-7. [PMID: 24052164 DOI: 10.1007/s00264-013-2099-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2013] [Accepted: 08/24/2013] [Indexed: 12/27/2022]
Abstract
PURPOSE The majority of patients experience a significant improvement in quality of life and function after total hip replacement (THR). It has recently been shown that age and good pre-operative function are the best predictors of postoperative function. When patients fail to achieve a satisfactory outcome, a cause is often identified. Where there is no identifiable cause, advice, follow-up and management is not clear. The aim of this study was to determine the long-term outcome of patients who had early poor function, but no identifiable cause. METHODS From a regional database, we identified 1,564 patients who underwent unilateral THR between 1998 and 2004 and who were without complication or subsequent bilateral procedure at six months. These patients were divided into two groups according to their Harris hip score (HHS) at this stage: group A consisted of 270 patients with a 'poor' result (HHS less than 70). Group B consisted of 1,294 patients with a 'good' or 'excellent' result (HHS 70 or above). The patients were reviewed at five years. One hundred and ten patients from group A and 980 from group B completed five-year follow-up without further identifiable complication. RESULTS Those with poor or fair function at six months were at an increased risk of developing an identified complication by five years including dislocation (OR 5.7, 95% CI 1.8-18.2), deep infection (OR 9.8, 95%CI 2.9-37.7) and death (OR 1.6, 95% CI 1.1-2.3). There was a greater rate of revision in group A versus group B (OR 5.7, 95% CI 2.9-11). The overall function measured by the Harris hip score significantly improved in group A, but never reached that of those with good or excellent function at six months (HHS 76.2 versus 90.3, P < 0.001). CONCLUSIONS Patients with poor function at six months, but no obvious cause, are at higher risk of developing complications by five years. This group may benefit from more regular arthroplasty review and intervention.
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Affiliation(s)
- Bruce S Watson
- Victoria Hospital, Hayfield Road, Kirkcaldy, KY2 5AH, UK
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