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Poursalehian M, Hassanzadeh A, Lotfi M, Mortazavi SMJ. Conversion of a Failed Hip Hemiarthroplasty to Total Hip Arthroplasty: A Systematic Review and Meta-Analysis. Arthroplast Today 2024; 28:101459. [PMID: 39100418 PMCID: PMC11295470 DOI: 10.1016/j.artd.2024.101459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 05/11/2024] [Accepted: 06/08/2024] [Indexed: 08/06/2024] Open
Abstract
Background Hip hemiarthroplasty (HA) and total hip arthroplasty (THA) are common treatments for femoral neck fractures in elderly patients. Despite HA's advantages of shorter operative times, less blood loss, and lower initial costs compared to primary THA, it may lead to conversion THA (cTHA). Our objectives are to evaluate the impact of conversion from HA to THA on Harris hip scores (HHS), compare complication rates between cTHA, revision THA, and primary THA, and assess the rates and types of complications following cTHA. Methods A systematic review and meta-analysis were performed, evaluating studies published until 2023, with inclusion criteria entailing studies that explored outcomes and complications following cTHA of failed HA. Data extraction focused on variables such as postoperative HHS and complication rates, including periprosthetic joint infection, periprosthetic fracture, dislocation, stem loosening, acetabular loosening, and overall revision. Results This study included 28 retrospective studies (4699 hips), showing a mean increase in HHS by 39.1 points, indicating a significant improvement from preoperative levels. Complication rates were detailed, with a 6.4% rate of periprosthetic joint infection, 2.2% for periprosthetic fracture, 7.6% dislocation, 1.6% stem loosening, 1.9% acetabular loosening, and an overall re-revision rate of 8.7%. Conclusions Conversion from HA to THA generally results in improved functional outcomes, as evidenced by HHS improvements. Despite the positive impact on HHS, cTHAs are associated with notable risks of complications and the need for further revision surgeries. Level of Evidence IV.
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Affiliation(s)
- Mohammad Poursalehian
- Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Hassanzadeh
- Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohadeseh Lotfi
- Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Schmitz PP, van Susante JLC, Sierevelt IN, Somford MP. The outcomes of conversion of hemiarthroplasty to total hip arthroplasty, a systematic review and meta-analysis. Arch Orthop Trauma Surg 2024; 144:2993-3001. [PMID: 38904682 DOI: 10.1007/s00402-024-05385-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 05/16/2024] [Indexed: 06/22/2024]
Abstract
INTRODUCTION Acetabular erosion is an important complication in hemiarthroplasty and may lead to total hip arthroplasty as a conversion. The results of total hip arthroplasty as a conversion remain unclear. We performed a systematic review and meta-analysis to compare the outcome of total hip arthroplasty as a conversion with primary total hip arthroplasty. MATERIALS AND METHODS PRISMA guidelines were used and Pubmed, Embase and the Cochrane libraries were searched. Both, studies comparing the outcome of total hip arthroplasty as a conversion with the outcome of primary total hip arthroplasty and the outcome of cohort studies limited to total hip arthroplasty as a conversion, were included. Risk of bias was assessed using the Methodological Index for Non Randomized Studies checklist. Meta-analysis was performed concerning pooled annual revision, dislocation and infection rates. RESULTS A total of 27 studies were available for analysis; four comparative studies and 23 cohort studies. Comparative studies were defined as high quality and cohort studies as medium quality. Analysis revealed a significantly higher overall revision risk (Hazard Ratio 1.72, 95% confidence interval 1.39 to 2.14) after total hip arthroplasty as a conversion compared to primary total hip arthroplasty. The annual revision rate of total hip arthroplasty as a conversion was 1.63% (95% confidence interval 1.14 to 2.33) in the comparative studies and 1.40% (95% confidence interval 1.17 to 1.66) in the cohort studies. A pooled infection rate of 4.34% (95% confidence interval 2.66 to 7.01) and dislocation rate of 4.79% (95% confidence interval 3.02 to 7.53), was found. CONCLUSIONS Literature concerning the results of total hip arthroplasty as a conversion is limited. The risk of revision after conversion of hemiarthroplasty is higher compared to primary total hip arthroplasty.
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Affiliation(s)
- Peter P Schmitz
- Department of Orthopedics, Rijnstate Hospital, postbox 9555, Arnhem, 6800, The Netherlands.
| | - Job L C van Susante
- Department of Orthopedics, Rijnstate Hospital, postbox 9555, Arnhem, 6800, The Netherlands
| | - Inger N Sierevelt
- SCORE (Specialized Centre of Orthopedic Research and education), Xpert Clinics, Orthopedic department, Amsterdam, The Netherlands
- Spaarne Gasthuis Academy, Orthopedic department, Hoofddorp, The Netherlands
| | - Matthijs P Somford
- Department of Orthopedics, Rijnstate Hospital, postbox 9555, Arnhem, 6800, The Netherlands
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Barimani B, Ramirez-GarciaLuna JL, Smith K, Hart A, Tanzer M. Capsular Repair Counteracts the Risk of Dislocation in Hemiarthroplasty Conversion to Total Hip Arthroplasty. Orthopedics 2022; 46:175-179. [PMID: 36508484 DOI: 10.3928/01477447-20221207-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
This study investigated whether decreasing the femoral head size, in addition to performing a posterior capsular closure and short external rotator repair, influences the historical rate of dislocation after conversion of a failed hemiarthroplasty (HA) to a total hip arthroplasty (THA) through a posterior approach. We reviewed 15 patients from our prospective arthroplasty database who underwent a conversion from an HA to a THA with closure of the posterior capsule, had downsizing of the femoral head, and had at least a 2-year follow-up. Patients were clinically observed to determine whether their hip dislocated postoperatively or required re-revision. Radiographs were evaluated to assess for known risk factors for dislocation, including component position and restoration of hip biomechanics. The femoral head size was downsized from a mean of 45 mm (range, 42-57 mm) preoperatively to a mean of 32 mm (range, 28-36 mm) postoperatively (P<.001). Femoral heads sized 36, 32, and 28 mm were used in the revision of 4, 5, and 6 hips, respectively. At the mean 84-month follow-up (range, 24-156 months), there were no dislocations. Attention to surgical technique and closing the posterior capsule can decrease the historically high dislocation rate associated with converting an HA to a total hip replacement using the posterolateral approach. Despite substantial reduction in size of the prosthetic femoral head, there were no postoperative dislocations with closure of the posterior capsule. Downsizing the femoral head during revision THA should be avoided; however, if not feasible, closure of the posterior capsule can offset the otherwise increased risk of dislocation. [Orthopedics. 202x;xx:xx-xx.].
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Cichos KH, Detweiler M, Parvizi J, McGwin G, Heatherly AR, Ghanem ES. The fate of positive intraoperative cultures following conversion total hip arthroplasty. Hip Int 2022; 32:17-24. [PMID: 32573261 DOI: 10.1177/1120700020936628] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION The objectives of this study are to report the rates of positive intraoperative cultures obtained during conversion total hip arthroplasty (THA) according to index surgery, and to describe the natural history of treatment for a consecutive series of patients with unexpected positive intraoperative cultures during conversion THA. METHODS We reviewed all patients at 2 institutions undergoing conversion THA from prior open reduction and internal fixation (ORIF) of acetabular and hip fractures or hemiarthroplasty for displaced femoral neck fractures from 2011 to 2018. Intraoperative cultures were taken in 105 patients. Positive intraoperative cultures during conversion were recorded and managed with an infectious diseases consult. The outcomes including PJI at 90 days and 1 year follow-up were documented. RESULTS Overall, 19 of 105 patients (18%) undergoing conversion THA had positive intraoperative cultures, with the highest rates in the hemiarthroplasty 7/16 (44%) and acetabular ORIF 9/48 (19%) groups. All 19 patients were initially treated conservatively: 8 received IV antibiotics, 10 received no additional therapy, and 1 received oral antibiotics. 4/9 acetabular fracture conversions developed PJI at 1 year, with 3 requiring multiple irrigation and debridement/polyethylene exchanges to control the infection while the 4th patient required 2-stage exchange. There were no 1-year PJI from any of the other index procedures after conversion. All 7 hemiarthroplasty patients with positive cultures were treated to resolution with 4-8 weeks IV antibiotics alone. CONCLUSIONS Patients undergoing conversion THA from prior hip or acetabular fracture have a high rate of positive intraoperative cultures. As such, all patients undergoing conversion THA from prior hip or acetabular fracture fixation should undergo thorough diagnostic workup prior to surgery, and have intraoperative cultures obtained during surgery if infection remains suspicious. Further work should be performed to develop MSIS criteria for preoperative management of patients undergoing conversion THA.
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Affiliation(s)
- Kyle H Cichos
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Maxwell Detweiler
- Department of Orthopaedic Surgery, Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Javad Parvizi
- Department of Orthopaedic Surgery, Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Gerald McGwin
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Elie S Ghanem
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
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Tanaka T, Kaneko T, Hidaka R, Hashikura K, Ishikura H, Moro T, Tanaka S. Midterm results of revision total hip arthroplasty for migrated bipolar hemiarthroplasty in patients with hip osteoarthritis using cementless cup with the rim-fit technique. J Orthop Surg (Hong Kong) 2021; 28:2309499020954315. [PMID: 32996412 DOI: 10.1177/2309499020954315] [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] [Indexed: 11/16/2022] Open
Abstract
PURPOSE The results of reamed bipolar hemiarthroplasty (BHA) in patients with hip osteoarthritis (OA) are reported to be unfavorable. Acetabular reaming for sufficient bony coverage caused bipolar head migration into the superomedial direction, and most patients required revision surgeries. Several methods are applicable to treat decreased bone stock. This study aimed to investigate the midterm results of revision surgeries using the cementless cup with the rim-fit technique. METHODS Between 1996 and 2014, acetabular revision surgeries using the cementless cup with the rim-fit technique were performed in 86 hips (74 patients). We evaluated radiographic outcomes, including positional change of the rotation center of the artificial femoral head, presence of implant loosening, and filling of the initial gap. We also evaluated clinical outcomes, including the Harris hip score (HHS), and postoperative complications. RESULTS The average positional changes from BHA to prerevision surgeries were 8.0 mm superiorly and 4.1 mm medially. The average changes from prerevision to postrevision surgeries were 3.7 mm inferiorly and 2.4 mm laterally. No implant loosening was found in all cases; the initial gap between the acetabular host bone and the acetabular cup was filled in 53 (93%) among 57 hips. The average HHS improved from 65.9 before revision surgeries to 83.8 in the latest follow-up. Dislocation and postoperative periprosthetic fracture occurred in two and five hips, respectively; no cases required rerevision surgeries. CONCLUSION There were favorable midterm results of the revision total hip arthroplasty for migrated BHA in patients with hip OA using cementless cup with the rim-fit technique.
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Affiliation(s)
- Takeyuki Tanaka
- Orthopaedic Surgery, Sensory and Motor System Medicine, Surgical Sciences, Graduate School of Medicine, 13143The University of Tokyo, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Taizo Kaneko
- Orthopaedic Surgery, Sensory and Motor System Medicine, Surgical Sciences, Graduate School of Medicine, 13143The University of Tokyo, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Ryo Hidaka
- Orthopaedic Surgery, Sensory and Motor System Medicine, Surgical Sciences, Graduate School of Medicine, 13143The University of Tokyo, Hongo, Bunkyo-ku, Tokyo, Japan.,Division of Science for Joint Reconstruction, Graduate School of Medicine, 13143The University of Tokyo, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Kazuaki Hashikura
- Orthopaedic Surgery, Sensory and Motor System Medicine, Surgical Sciences, Graduate School of Medicine, 13143The University of Tokyo, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Hisatoshi Ishikura
- Orthopaedic Surgery, Sensory and Motor System Medicine, Surgical Sciences, Graduate School of Medicine, 13143The University of Tokyo, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Toru Moro
- Orthopaedic Surgery, Sensory and Motor System Medicine, Surgical Sciences, Graduate School of Medicine, 13143The University of Tokyo, Hongo, Bunkyo-ku, Tokyo, Japan.,Division of Science for Joint Reconstruction, Graduate School of Medicine, 13143The University of Tokyo, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Sakae Tanaka
- Orthopaedic Surgery, Sensory and Motor System Medicine, Surgical Sciences, Graduate School of Medicine, 13143The University of Tokyo, Hongo, Bunkyo-ku, Tokyo, Japan
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Hernandez NM, Fruth KM, Larson DR, Kremers HM, Sierra RJ. Conversion of Failed Hemiarthroplasty to Total Hip Arthroplasty Remains High Risk for Subsequent Complications. J Arthroplasty 2019; 34:2030-2036. [PMID: 31147247 DOI: 10.1016/j.arth.2019.04.042] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 04/12/2019] [Accepted: 04/19/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Few studies have described the outcomes following conversion of failed hemiarthroplasties to total hip arthroplasty (THA) and the impact of mortality when estimating implant survivorship. The aims of this study were to evaluate the following: (1) the risks and predictors of complications, dislocations, reoperations, and revisions and (2) the extent of competing risk of death when evaluating outcomes in patients converted from hemiarthroplasty to THA. METHODS The study comprised 389 patients treated with conversion THA following hemiarthroplasty for femoral neck fractures between 1985 and 2014. Revision rates were calculated using both the Kaplan-Meier method and cumulative incidence accounting for death as a competing risk. Risk factors were evaluated using Cox regression models. RESULTS During an average 9.3 years of follow-up, there were 122 complications, 34 dislocations, 69 reoperations, and 51 revisions. Conversion for periprosthetic fractures was associated with a higher risk of reoperations (hazard ratio 4.30, 95% confidence interval 1.94-9.52). Increasing age was a risk factor for reoperations (hazard ratio 1.32, 95% confidence interval 1.10-1.59). No decrease in the rate of complications, dislocations, reoperations, or revisions was observed over the entire 30 years of the study either when evaluating year of surgery as a continuous variable or when comparing specific calendar year intervals (1985-1989, 1990-1999, 2000-2009, 2010-2014) (P > .05). Compared to the cumulative incidence accounting for the competing risk of death, the Kaplan-Meier method overestimated the risk of revision by 7% at 15 years and 10% at 20 years. CONCLUSION Conversion from hemiarthroplasty to THA remains at high risk for subsequent complications. The cumulative incidence estimate provides a more accurate estimate of revision risk.
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Affiliation(s)
| | - Kristin M Fruth
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Dirk R Larson
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | | | - Rafael J Sierra
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
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Sarpong NO, Grosso MJ, Lakra A, Held MB, Herndon CL, Cooper HJ. Hemiarthroplasty Conversion: A Comparison to Primary and Revision Total Hip Arthroplasty. J Arthroplasty 2019; 34:1168-1173. [PMID: 30890392 DOI: 10.1016/j.arth.2019.02.043] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 02/13/2019] [Accepted: 02/20/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Arthroplasty is the standard of care for elderly patients with displaced femoral neck fractures, with viable options including hemiarthroplasty (HA) and total hip arthroplasty (THA). With time, HA may need to be converted to THA, but it is unclear whether this is more similar to primary or revision THA. We compare complication and revision rates between these groups within 90 days and 2 years postoperatively. METHODS We retrospectively reviewed 3 cohorts of patients treated at our institution: primary, conversion, and revision THA. Outcomes studied included intraoperative data, postoperative complications, and revision rates. We analyzed the groups using both parametric (analysis of variance test) and nonparametric (chi-squared test) statistics. RESULTS Operative time between primary THA (108.0 minutes), conversion HA (147.9 minutes), and revision THA (160.1 minutes) cohorts differed significantly (P = .011). Estimated blood loss was also different between primary THA (386 mL), conversion HA (587 mL), and revision THA cohorts (529 mL) (P = .011). At 2 years, major complication rates between primary THA (6.2%), conversion HA (11.7%), and revision THA (26.7%) cohorts also differed significantly (P = .003), as was the revision rate in the primary THA (4.6%), conversion HA (10.0%), and revision THA (18.3%) cohorts (P = .043). CONCLUSION This is the first study to compare short-term and midterm complications between primary, conversion, and revision THA. We observed conversion HA had similar operative time and estimated blood loss to revision THA, which was significantly higher than primary THA. However, we found that conversion HA more closely resembled primary THA with respect to perioperative complications rates.
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Affiliation(s)
- Nana O Sarpong
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York
| | - Matthew J Grosso
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York
| | - Akshay Lakra
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York
| | - Michael B Held
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York
| | - Carl L Herndon
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York
| | - H John Cooper
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, New York
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Conversion of Hemiarthroplasty to THA Carries an Increased Risk of Reoperation Compared With Primary and Revision THA. Clin Orthop Relat Res 2019; 477:1392-1399. [PMID: 31136440 PMCID: PMC6554100 DOI: 10.1097/corr.0000000000000702] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND There is limited information on the complications and costs of conversion THA after hemiarthroplasty for femoral neck fractures. Previous studies have found that patients undergoing conversion THA experience higher risk complications, but it has been difficult to quantify the risk because of small sample sizes and a lack of comparison groups. Therefore, we compared the complications of patients undergoing conversion THA with strictly matched patients undergoing primary and revision THA. QUESTIONS/PURPOSES (1) What are the risks of complications, dislocations, reoperations, revisions and periprosthetic fractures after conversion THA compared with primary and revision THA and how has this effect changed over time? (2) What are the length of hospital stay and hospital costs for conversion THA, primary THA, and revision THA? METHODS Using a longitudinally maintained total joint registry, we identified 389 patients who were treated with conversion THA after hemiarthroplasty for femoral neck fractures between 1985 and 2014. The conversion THA cohort was 1:2 matched on age, sex, and year of surgery to 778 patients undergoing primary THA and 778 patients undergoing revision THA. The proportion of patients having at least 5-year followup was 73% in those who underwent conversion THA, 77% in those who underwent primary THA, and 76% in those who underwent revision THA. We observed a significant calendar year effect, and therefore, compared the three groups across two separate time periods: 1985 to 1999 and 2000 to 2014. We ascertained complications, dislocations, reoperations, revisions and periprosthetic fractures from the total joint registry. Cost analysis was performed using a bottom-up, microcosting methodology for procedures between 2003 and 2014. RESULTS Patients who converted to THA between 1985 and 1999 had a higher risk of complications (hazard ratio [HR], 2.3; 95% confidence interval [CI], 1.7-3.1; p < 0.001), dislocations (HR, 2.3; 95% CI, 1.3-4.2; p = 0.007), reoperations (HR, 1.7; 95% CI, 1.2-2.5, p = 0.005), and periprosthetic fractures (HR, 3.8; 95% CI, 2.2-6.6; p < 0.001) compared with primary THA. However, conversion THAs during the 1985 to 1999 time period had a lower risk of reoperations (HR, 0.7; 95% CI, 0.5-1.0; p = 0.037), revisions (HR, 0.6; 95% CI, 0.5-0.9; p = 0.014), and periprosthetic fractures (HR, 0.6; 95% CI, 0.4-0.9; p = 0.007) compared with revision THA. The risk differences across the three groups were more pronounced after 2000, particularly when comparing conversion THA patients with revision THA. Conversion THA patients had a higher risk of reoperations (HR, 1.9; 95% CI, 1.0-3.4; p = 0.041) and periprosthetic fractures (HR, 1.7; 95% CI, 1.0-2.9; p = 0.036) compared with revision THA, but there were no differences in the complication risk (HR, 1.4; 95% CI, 0.9-2.1; p = 0.120), dislocations (HR, 1.5; 95% CI, 0.7-3.2; p = 0.274), and revisions (HR, 1.4; 95% CI, 0.7-3.0; p = 0.373). Length of stay for conversion THA was longer than primary THA (4.7 versus 4.0 days; p = 0.012), but there was no difference compared with revision THA (4.7 versus 4.5 days; p = 0.484). Similarly, total inpatient costs for conversion THA were higher than primary THA (USD 22,662 versus USD 18,694; p < 0.001), but there was no difference compared with revision THA (USD 22,662 versus USD 22,071; p = 0.564). CONCLUSIONS Over the 30 years of the study, conversion THA has remained a higher risk procedure in terms of reoperation compared with primary THA, and over time, it also has become higher risk compared with revision THA. Surgeons should approach conversion THA as a challenging procedure, and patients undergoing this procedure should be counseled about the elevated risks. Furthermore, hospitals should seek appropriate reimbursement for these cases. LEVEL OF EVIDENCE Level III, therapeutic study.
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Abstract
Hemiarthroplasty is a common procedure for treatment of displaced femoral neck fractures in low-demand patients. As hip fracture incidence continues to increase, the need for revision hemiarthroplasty is also expected to increase. Multiple etiologies can result in a failed hemiarthroplasty, including persistent pain, infection, instability, leg-length discrepancy, and trauma. Preoperative clinical, radiographic, and laboratory assessments are critical in determining the etiology of the painful hemiarthroplasty. The standard of care for surgical management of failed hemiarthroplasty is conversion to a total hip arthroplasty. However, establishing the etiology preoperatively is essential to planning before treating the failed hemiarthroplasty.
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Newman JM, Webb MR, Klika AK, Murray TG, Barsoum WK, Higuera CA. Quantifying Blood Loss and Transfusion Risk After Primary vs Conversion Total Hip Arthroplasty. J Arthroplasty 2017; 32:1902-1909. [PMID: 28236548 DOI: 10.1016/j.arth.2017.01.038] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 01/16/2017] [Accepted: 01/22/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Primary total hip arthroplasty (THA) and conversion THA may result in substantial blood loss, sometimes necessitating transfusion. Despite the complexities of the latter, both are grouped in the same category for quality assessment and reimbursement. This study's purpose was to compare both blood loss and transfusion risk in primary and conversion THA and identify their associated predictors. METHODS A total of 1616 patients who underwent primary and conversion THA at a single hospital from 2009-2013 were reviewed (primary THA = 1575; conversion THA = 41). Demographics, comorbidities, and perioperative data were collected from electronic records. Blood loss was calculated using a validated method. Transfusion triggers were based on standardized criteria. Separate multivariable regression models for blood loss and transfusion were performed. RESULTS Conversion THA patients were younger (P = .002), had lower age-adjusted Charlson scores (P = .006), longer surgeries (P < .001), higher blood loss (P < .001), and more transfusions (P < .001). Primary and conversion THA groups were different in terms of surgical approach (P < .001), anesthesia type (P = .002), and venous thromboembolism prophylaxis (P = .01). Compared to primary THA, conversion THA had an average 478.9 mL higher blood loss (P = .003) and increased adjusted odds ratio of 3.2 (P = .019) for transfusion. CONCLUSION Conversion THA leads to higher blood loss and transfusion compared with primary THA. These differences were quantified in the present study and showed consistent results between the 2 metrics. The differences between these procedures should be addressed during quality assurance because conversion THA is associated with higher resource utilization, which is important in the allocation of resources and tiered reimbursement strategies.
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Affiliation(s)
- Jared M Newman
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Matthew R Webb
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Alison K Klika
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Trevor G Murray
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Wael K Barsoum
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Carlos A Higuera
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
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Kaku N, Tabata T, Tagomori H, Tsumura H. Isolated acetabular revision with femoral stem retention after bipolar hip arthroplasty. Arch Orthop Trauma Surg 2017; 137:425-430. [PMID: 28150224 DOI: 10.1007/s00402-017-2633-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Indexed: 12/01/2022]
Abstract
INTRODUCTION In bipolar hemiarthroplasty, migration of the outer cup component into the acetabular cup, with evidence of severe osteolysis in the acetabulum, commonly occurs without loosening of the femoral component. The merits of retaining the stable femoral component in these cases have been debated. Our study aimed to determine whether revision of the acetabular component in isolation could be successfully performed. MATERIALS AND METHODS The data of 54 patients (61 hips), 44 women, and 10 men, aged 67.7 (range 47-86) years at the time of the index revision, were analyzed. The average time from primary operation to revision surgery was 14.9 (range 1.0-27.0) years, with an average follow-up time after revision of 5.2 (range, 1.0-18.7) years. Indications for acetabular revision included migration of the outer cup component (N = 55), disassembly of the bipolar cup (N = 4), and recurrent dislocation (N = 2). Fixation of the femoral stem was cementless in 49 hips and cemented in 12. Bone grafting for osteolysis of the proximal femur around the stem was performed in six hips. An acetabular reinforcement ring with a cemented cup was used in 31 hips, with cementless cup fixation in 29 hips, and cemented cup in one case. RESULTS On average, the Harris hip score improved from 57.0 ± 21.6 to 87.4 ± 6.40 points after revision. Two cases of femoral periprosthetic fracture were treated with osteosynthesis 3 year post-revision. There was no evidence of loosening of the femoral stem or subsidence, with a non-progressive radiolucent line <2 mm identified in one case. There was no incidence of dislocation or deep infection, and all components were judged to be stable at the final follow-up. CONCLUSION Isolated acetabular revision can be reliably performed in cases of failed bipolar hemiarthroplasty with a well-fixed femoral component.
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Affiliation(s)
- Nobuhiro Kaku
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi Yufu city, Oita, 879-5593, Japan.
| | - Tomonori Tabata
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi Yufu city, Oita, 879-5593, Japan
| | - Hiroaki Tagomori
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi Yufu city, Oita, 879-5593, Japan
| | - Hiroshi Tsumura
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi Yufu city, Oita, 879-5593, Japan
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What are the risk factors for post-operative infection after hip hemiarthroplasty? Systematic review of literature. INTERNATIONAL ORTHOPAEDICS 2015; 40:1843-8. [DOI: 10.1007/s00264-015-3033-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 11/01/2015] [Indexed: 12/21/2022]
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