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Loppini M, Bella LL, Rocchi C, Morenghi E, Chiappetta K, Rusconi R, Grappiolo G. Identification of preoperative predictive markers of periprosthetic joint infection in presumed aseptic revisions of total hip arthroplasty: a retrospective observational study. Arch Orthop Trauma Surg 2024; 145:38. [PMID: 39665838 DOI: 10.1007/s00402-024-05706-7] [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: 07/25/2024] [Accepted: 11/27/2024] [Indexed: 12/13/2024]
Abstract
INTRODUCTION Periprosthetic joint infections (PJIs) occur at a rate of 1-2% in primary arthroplasties and 4% in revisions, posing a significant healthcare challenge. PJI diagnosis is hindered by absence of a universally accepted diagnostic standard. The primary outcome was to develop a predictive model to identify patients at risk of developing unforeseen PJI subsequent to presumed aseptic revision of total hip arthroplasty (THA). The secondary aim was to determine the reintervention-free survival rate among aseptic patients and those presenting unexpected positive cultures. METHODS This study included all ascertained septic and presumed aseptic patients without mechanical causes of THA failure and with sufficient clinical and laboratory data. Patients with incomplete anamnestic data, mechanical loosening related causes, rheumatologic conditions, or immunosuppression were excluded. Univariable and multivariable logistic regression analyses identified preoperative predictive markers for unexpected hip PJI. RESULTS 283 inpatients from a high volume referral center were recruited from 2016 to 2019. The predictive preoperative parameters related with hip PJI were: presence of comorbidities (OR: 0.28; 95% CI 0.10-0.78), erythrocyte sedimentation rate (OR: 1.02; 95% CI 1.00-1.03), leukocyte count (OR: 1.18; 95% CI 1.02-1.36) and prothrombin time (OR: 1.42; 95% CI 1.02-1.98). Gender, age, body mass index (BMI) and previous surgery were not significantly related with unexpected PJI. Overall, the Kaplan-Meier analysis estimated a reoperation-free survival rate at 36 months of 96% (CI 95%) for the aseptic and 98% (CI 95%) for the unexpected group; however, the relation between the two survival curves was not significant (p = 0.086). CONCLUSIONS Erythrocyte sedimentation rate, leukocyte count, and increased prothrombin time were risk factors for PJI, whereas comorbidities were associated with a lower risk. Further research is needed to understand this association fully. Larger datasets are recommended to explore the complex interplay between risk factors and PJI development.
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Affiliation(s)
- Mattia Loppini
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele - Milan, 20090, Italy.
- IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano - Milan, 20089, Italy.
- Fondazione Livio Sciutto Onlus, Campus Savona - Università degli Studi di Genova, Via Magliotto 2, Savona, 17100, Italy.
| | - Ludovico La Bella
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele - Milan, 20090, Italy
| | - Caterina Rocchi
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele - Milan, 20090, Italy
| | - Emanuela Morenghi
- IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano - Milan, 20089, Italy
| | - Katia Chiappetta
- IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano - Milan, 20089, Italy
- Fondazione Livio Sciutto Onlus, Campus Savona - Università degli Studi di Genova, Via Magliotto 2, Savona, 17100, Italy
| | - Roberto Rusconi
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele - Milan, 20090, Italy
- IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano - Milan, 20089, Italy
| | - Guido Grappiolo
- IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano - Milan, 20089, Italy
- Fondazione Livio Sciutto Onlus, Campus Savona - Università degli Studi di Genova, Via Magliotto 2, Savona, 17100, Italy
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Egerci OF, Yapar A, Dogruoz F, Selcuk H, Kose O. Preventive strategies to reduce the rate of periprosthetic infections in total joint arthroplasty; a comprehensive review. Arch Orthop Trauma Surg 2024; 144:5131-5146. [PMID: 38635048 PMCID: PMC11602800 DOI: 10.1007/s00402-024-05301-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 03/24/2024] [Indexed: 04/19/2024]
Abstract
The increasing frequency of total hip (THA) and knee arthroplasties (TKA) is marred by the rise in periprosthetic joint infections (PJIs) and surgical site infections (SSIs), with PJIs incurring costs over $1.62 billion as of 2020 and individual case management averaging $90,000. SSIs additionally burden the U.S. healthcare economy with billions in expenses annually. PJI prevalence in primary THA and TKA ranges from 0.5% to 2.4%, spiking to 20% in revisions and representing 25% of TKA revision causes. Projections estimate up to 270,000 annual PJI cases by 2030. Often caused by gram-positive bacteria, particularly methicillin-resistant staphylococci, these infections demand preventive measures. This review dissects PJI prevention across preoperative, intraoperative, and perioperative phases, aligning with evidence-based CDC and WHO guidelines. Preoperative measures include managing diabetes, obesity, tobacco use, Staphylococcus aureus screening and nasal decolonization, nutritional optimization, and management of inflammatory arthropathies. Intraoperatively, antibiotic prophylaxis, skin preparation, operative room environmental controls, surgical technique precision, and irrigation options are scrutinized. Perioperative concerns focus on anticoagulation, blood management, and infection risk mitigation. Integrating these strategies promotes a patient-centric care model, aiming to reduce PJI incidence, improve patient outcomes, and increase care cost-effectiveness in joint arthroplasty.
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Affiliation(s)
- Omer Faruk Egerci
- Department of Orthopedics and Traumatology, Antalya Training and Research Hospital, Antalya, Turkey
| | - Aliekber Yapar
- Department of Orthopedics and Traumatology, Antalya Training and Research Hospital, Antalya, Turkey
| | - Fırat Dogruoz
- Department of Orthopedics and Traumatology, Antalya Training and Research Hospital, Antalya, Turkey
| | - Huseyin Selcuk
- Department of Orthopedics and Traumatology, Antalya Training and Research Hospital, Antalya, Turkey
| | - Ozkan Kose
- Department of Orthopedics and Traumatology, Antalya Training and Research Hospital, Antalya, Turkey.
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Ahsan P, Rahaman MM, Jahan I, Asma NS, Paran MS, Shaude SE. Two Stage Revision Total Hip Arthroplasty for Enterobacter Induced Periprosthetic Joint Infection in an Elderly Female: A Case Report. J Orthop Case Rep 2024; 14:103-109. [PMID: 39524281 PMCID: PMC11546037 DOI: 10.13107/jocr.2024.v14.i11.4930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2024] [Revised: 09/26/2024] [Indexed: 11/16/2024] Open
Abstract
Introduction Periprosthetic joint infections (PJIs) present a growing challenging complication in joint surgeries, with increasing incidence and significant clinical implications. The complexity of PJIs lies in its interaction between microbes and the host immune response. While Enterobacter infections are rare in PJIs, they pose severe risks due to their resistance and virulence. PJIs burden healthcare systems and profoundly impact patients, especially those unable to access necessary treatments due to socioeconomic limitations, like our patient who had suffered from excruciating pain and immobility for 6 years. To the best of our knowledge, this is the first case report of its kind. Case Report A 55-year-old woman presented to us with severe right hip pain for 10 years and recurrent swelling over the incisional site with discharging sinus and intermittent fever for 6 years. She underwent through a unipolar hemiarthroplasty due to right-sided femoral neck fracture 10 years back. Severe pain and recurrent infections led to functional limitations and deteriorating quality of life. History, clinical examination, serological, and radiological investigations confirmed the diagnosis. Two-stage revision total hip arthroplasty was performed. Regular follow-ups were done after the surgical procedure. After revision, she experienced no pain or recurrence of infection. Her Harris Hip Scores were 9 and 80 before and after two-stage revision surgery, indicating a favorable outcome. Conclusion This case highlights the challenges of PJI management, especially in patients from poor socioeconomic condition. Despite obstacles, intervention with two-stage revision arthroplasty resulted in significant clinical and psychological improvement. Enhanced healthcare accessibility and tailored interventions are crucial for optimizing PJI outcomes.
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Affiliation(s)
- Pervez Ahsan
- Department of Orthopedic Surgery, Ibn Sina Medical College and Hospital, Dhaka, Bangladesh
| | - Md. Mostafizur Rahaman
- Department of Orthopedic Surgery, Ibn Sina Medical College and Hospital, Dhaka, Bangladesh
| | - Israt Jahan
- Department of Orthopedic Surgery, Ibn Sina Medical College and Hospital, Dhaka, Bangladesh
| | - Nusrat Sharmin Asma
- Department of Orthopedic Surgery, Ibn Sina Medical College and Hospital, Dhaka, Bangladesh
| | - Md. Shah Paran
- Department of Orthopedic Surgery, Ibn Sina Medical College and Hospital, Dhaka, Bangladesh
| | - Syed E Shaude
- Department of Research and Development, International Network of Doctors Journal, Dhaka, Bangladesh
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Cimatti P, Del Piccolo N, Dallari B, Mazzotta A, Dallari D. Use of morselized bone allograft in revision hip arthroplasty for massive acetabular defect: A systematic review and meta-analysis. J Exp Orthop 2024; 11:e70091. [PMID: 39634575 PMCID: PMC11615971 DOI: 10.1002/jeo2.70091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Revised: 10/07/2024] [Accepted: 10/10/2024] [Indexed: 12/07/2024] Open
Abstract
Purpose Many treatment options are available for the revision of large acetabular defects. Debate continues as to which technique is most effective. This meta-analysis aimed to determine the rates of failure of acetabular bone defects Paprosky type III or American Academy of Orthopaedic types III-IV treated with morselized allograft in association with cemented cup or cementless cup or reinforcement devices. Methods The US National Library of Medicine (PubMed/MEDLINE), EMBASE and the Cochrane Database of Systematic Reviews were queried for publications from January 1980 to 1 April 2024 utilizing keywords pertinent to total hip arthroplasty (THA), acetabular impaction bone grafting and revision THA. The main outcome measure was the 9-year implant failure rate. Results Thirty-nine articles were eligible for inclusion in the current study. We found 41 treatment approaches that we grouped into three different treatment options: 1 = morselized allograft and cemented cup (10 studies); 2 =morselized allograft and cementless cup (nine studies); 3 = morselized allograft and device (22 studies). The overall implant failure rate was 2.1% (95% confidence interval [CI], 1.6%-2.8%) at a mean of 9.2 years. There was no significant difference in failure rates between different treatment options (1.6% [95% CI, 0.9%-2.6%]) for morselized allograft and cemented cup; 2.1% (95% CI, 1.4%-3.2%) for morselized allograft and cementless cup; 2.5% (95% CI, 1.7%-3.7%) for morselized allograft and device) between the three different types of treatment (heterogeneity between groups p = 0.351).It was determined that the number one cause of failure was aseptic loosening (80.5%), followed by infection (13.1%) and dislocation (6.4%). THA with reinforcement devices has a higher incidence of infection (3.6 vs. 0.7%, p = 0.001) and dislocation (1.4 vs. 0.6%, p = 0.010) than THA with a cemented cup. Conclusions The use of morselized allograft in hip revision of large acetabular defects has low implant failure rates, independently of the associated type of implant. Reinforcement devices increase the risk of re-revision for infection and dislocation. Level of Evidence Level III.
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Affiliation(s)
- Pietro Cimatti
- Reconstructive Orthopaedic Surgery Innovative Techniques—Musculoskeletal Tissue BankIRCCS Istituto Ortopedico RizzoliBolognaItaly
- Department of Surgical Sciences and Innovative TechnologiesUniversity of Bologna—Alma Mater StudiorumBolognaItaly
| | - Nicolandrea Del Piccolo
- Reconstructive Orthopaedic Surgery Innovative Techniques—Musculoskeletal Tissue BankIRCCS Istituto Ortopedico RizzoliBolognaItaly
| | - Benedetta Dallari
- Reconstructive Orthopaedic Surgery Innovative Techniques—Musculoskeletal Tissue BankIRCCS Istituto Ortopedico RizzoliBolognaItaly
| | - Alessandro Mazzotta
- Reconstructive Orthopaedic Surgery Innovative Techniques—Musculoskeletal Tissue BankIRCCS Istituto Ortopedico RizzoliBolognaItaly
| | - Dante Dallari
- Reconstructive Orthopaedic Surgery Innovative Techniques—Musculoskeletal Tissue BankIRCCS Istituto Ortopedico RizzoliBolognaItaly
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Ojeda-Thies C, Rojo-Carpintero A, Soria-Perdomo F, Ramos-Pascua LR. "Implant-associated infection after hip fracture surgery in elderly patients: Risk factors and mortality". Injury 2024; 55 Suppl 5:111756. [PMID: 39581658 DOI: 10.1016/j.injury.2024.111756] [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: 04/09/2024] [Revised: 06/08/2024] [Accepted: 07/28/2024] [Indexed: 11/26/2024]
Abstract
AIMS Our study aimed to evaluate the prognosis of implant-related infection following hip fracture and pre-surgical, surgical and microbiological factors modifying outcomes. METHODS We retrospectively included patients aged 65 and older treated for infection following surgically managed hip fractures between 2012 and 2022. Periprosthetic and high-energy fractures were excluded. Data was obtained by clinical chart review, including: age, gender, Barthel index, Charlson Score, National Hip Fracture Database (NHFD) Mobility Score, surgery and infection type, causative pathogens, antimicrobial resistance, anti-biofilm antibiotic treatment and clinical situation at one-year follow up. The outcomes evaluated were failure/resolution of infection and one-year mortality. RESULTS We included 80 patients (67 women, 83.8 %) aged a median of 85 years (interquartile range: 78 - 88 years). Treatment failed in 38 (47.5 %) patients, and the one-year mortality was 37.5 %. Patients dying within 12 months after treatment were more likely to suffer acute vs. chronic infections (OR = 3.29 [95 %CI: 1.20-9.04]), be older and have more comorbidity, but baseline function and ambulation were not predictive. Treatment failure was higher among patients receiving non-antibiofilm controlling surgery, specifically surgical lavage (OR = 3.79 [95 %CI: 1.38-10,37]), as well as in older, more dependent patients. Receiving anti-biofilm antibiotics for more than 2 weeks was associated with less treatment failure (OR:0.32; [95 %CI: 0.13-0.80]) and 12-month mortality (OR:0.22 [95 %CI: 0.08-0.60]). CONCLUSIONS Antibiofilm-controlling surgery and antibiotics improve treatment success following implant-related infection after hip fracture and should be considered regardless of fracture type. Acute infections are a "second hit" for frail patients recovering from initial surgery and are associated with increased mortality.
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Affiliation(s)
- Cristina Ojeda-Thies
- Department of Traumatology and Orthopaedic Surgery, 12 de Octubre University Hospital Madrid, Spain.
| | | | - Francisco Soria-Perdomo
- School of Medicine. Complutense University of Madrid, Spain; Geriatric Unit, 12 de Octubre University Hospital Madrid, Spain
| | - Luis Rafael Ramos-Pascua
- Department of Traumatology and Orthopaedic Surgery, 12 de Octubre University Hospital Madrid, Spain; School of Medicine. Complutense University of Madrid, Spain
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Sørensen RR, Timm S, Rasmussen LE, Brasen CL, Varnum C. Metabolic Syndrome and Morbid Obesity are Not Risk Factors for Revision Surgery in Patients Undergoing Hip and Knee Arthroplasty. J Arthroplasty 2024; 39:2440-2445. [PMID: 39025274 DOI: 10.1016/j.arth.2024.07.013] [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: 03/04/2024] [Revised: 07/02/2024] [Accepted: 07/08/2024] [Indexed: 07/20/2024] Open
Abstract
BACKGROUND The effect of metabolic syndrome (MetS) on the risk of revision after hip and knee arthroplasty is debated. The aim of our study was to investigate the risk of short-term (minimum 2.7 years) revision due to periprosthetic joint infection (PJI) after hip and knee arthroplasty. Secondly, we aimed to investigate the risk of revision due to any cause and mortality. METHODS During May 2017 to November 2019, a cohort of 2,901 patients undergoing a total of 3,024 hip and knee arthroplasties was established. In the cohort, 62.1% met the criteria for MetS. Data from national registries and a local database were used to determine the presence of MetS and revision surgeries, with a follow-up of at least two years and eight months. Cox regression was applied to the present hazard ratio (HR), associated 95% confidence intervals, and P values. Survival analyses were presented in a Kaplan-Meier plot. RESULTS The risk of PJI (HR 1.6 (0.5 to 4.9), P = .380), any revision (HR 0.8 (0.4 to 1.3), P = .295), and death (HR 1.3 (0.8 to 2.1), P = .282) was not increased in patients suffering from MetS compared with patients who did not have MetS. There was no PJI in patients not having MetS and receiving a knee arthroplasty. The risk of death was increased in the MetS group receiving a knee arthroplasty (HR 2.7 (1.3 to 5.9), P = .010), but not different from the MetS group receiving a hip arthroplasty. There was no elevated risk of PJI when analyzing morbid obesity (body mass index over 40), men, or diabetes as the exposures. CONCLUSIONS Patients suffering from MetS do not have an increased risk of revision caused by PJI. In general, performing hip and knee arthroplasty in patients suffering from MetS is without increased risk of revision surgery.
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Affiliation(s)
- Rasmus R Sørensen
- Department of Orthopaedic Surgery, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark
| | - Signe Timm
- Department of Orthopaedic Surgery, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark; Department of Regional Health Research, University of Southern Denmark, Odense M, Denmark
| | - Lasse E Rasmussen
- Department of Orthopaedic Surgery, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark
| | - Claus L Brasen
- Department of Immunology and Biochemistry, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark
| | - Claus Varnum
- Department of Orthopaedic Surgery, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark; Department of Regional Health Research, University of Southern Denmark, Odense M, Denmark
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Geraci G, Di Martino A, Stefanini N, Brunello M, Ruta F, Pilla F, Traina F, Faldini C. Should we be concerned when the anterior approach to the hip goes accidentally medial? A retrospective study. ARTHROPLASTY 2024; 6:47. [PMID: 39217376 PMCID: PMC11366135 DOI: 10.1186/s42836-024-00269-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 07/07/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND The direct anterior approach is increasingly used for primary total hip arthroplasty (THA) due to its minimally invasive nature and rapid recovery time. Difficulties in identifying the correct intermuscular interval can arise during the procedure, sometimes resulting in excessive medial exposure. This study aimed to evaluate demographics and risk factors, outcomes, and potential complications in those THA patients in which a medialized approach was performed. METHODS We retrospectively reviewed cases of anterior THA to identify cases where the surgical approach to the hip was more medial than the standard interval. Demographic data, operative time, blood loss, intraoperative and postoperative complications, radiographic findings were collected and compared with a control group of 50 THA performed using the standard anterior intermuscular interval. RESULTS In a series of 1,450 anterior total hip arthroplasty (THA) procedures performed between January 2018 and December 2021, with an average follow-up of 33 ± 22.3 months, six patients (0.4%) had a medialized surgical interval. In one case the superficial layer was medial to the sartorious muscle while in the other five cases, the interval was lateral to the sartorius superficially, and medial to the rectus femoris deeply. Four out of 6 patients (66.6%) showed neuropraxia affecting the femoral nerve, and 3 out of 6 (50%) had involvement of the lateral femoral cutaneous nerve. In 6 out of 6 patients (100%), surgery was performed during the learning curve of DAA. No patients in the control group developed femoral nerve neuropraxia, and 2 out of 50 patients (4%) showed involvement of the lateral femoral cutaneous nerve. DISCUSSION AND CONCLUSION The anterior approach can rarely result in excessive medial exposure to the hip joint, especially during the learning curve. In our study cohort, an increased rate of neurological complications and reduced outcomes were observed, thereby rendering this event of particular clinical significance. To avoid unconventional intermuscular intervals, patient positioning and correct identification of the muscle bellies by recognizing the orientation of the muscle fibers are useful, together with the identification and ligation of the circumflex vessels, to ensure the identification of the correct intermuscular interval.
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Affiliation(s)
- Giuseppe Geraci
- 1st Orthopaedic and Traumatologic Department, IRCCS Rizzoli Orthopedic Institute, Via G.C. Pupilli 1, Bologna, 40136, Italy
- Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, 40136, Bologna, Italy
| | - Alberto Di Martino
- 1st Orthopaedic and Traumatologic Department, IRCCS Rizzoli Orthopedic Institute, Via G.C. Pupilli 1, Bologna, 40136, Italy.
- Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, 40136, Bologna, Italy.
| | - Niccolò Stefanini
- 1st Orthopaedic and Traumatologic Department, IRCCS Rizzoli Orthopedic Institute, Via G.C. Pupilli 1, Bologna, 40136, Italy
- Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, 40136, Bologna, Italy
| | - Matteo Brunello
- 1st Orthopaedic and Traumatologic Department, IRCCS Rizzoli Orthopedic Institute, Via G.C. Pupilli 1, Bologna, 40136, Italy
- Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, 40136, Bologna, Italy
| | - Federico Ruta
- 1st Orthopaedic and Traumatologic Department, IRCCS Rizzoli Orthopedic Institute, Via G.C. Pupilli 1, Bologna, 40136, Italy
- Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, 40136, Bologna, Italy
| | - Federico Pilla
- 1st Orthopaedic and Traumatologic Department, IRCCS Rizzoli Orthopedic Institute, Via G.C. Pupilli 1, Bologna, 40136, Italy
| | - Francesco Traina
- 1st Orthopaedic and Traumatologic Department, IRCCS Rizzoli Orthopedic Institute, Via G.C. Pupilli 1, Bologna, 40136, Italy
- Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, 40136, Bologna, Italy
| | - Cesare Faldini
- 1st Orthopaedic and Traumatologic Department, IRCCS Rizzoli Orthopedic Institute, Via G.C. Pupilli 1, Bologna, 40136, Italy
- Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, 40136, Bologna, Italy
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Karczewski D, Salmons HI, Thapa P, Tande AJ, Bedard NA, Berry DJ, Abdel MP. Periprosthetic Hip and Knee Infection: Is an Ipsilateral Uninfected Total Joint Arthroplasty at Risk? J Arthroplasty 2024; 39:S425-S428. [PMID: 38518960 DOI: 10.1016/j.arth.2024.03.034] [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: 12/15/2023] [Revised: 02/27/2024] [Accepted: 03/15/2024] [Indexed: 03/24/2024] Open
Abstract
BACKGROUND Periprosthetic joint infections (PJIs) of total hip arthroplasty (THA) or total knee arthroplasty (TKA) may occur in the setting of an uninfected ipsilateral prosthetic joint. However, the risk to that uninfected ipsilateral joint is unknown. We analyzed the survivorship free from PJI in at risk THAs and TKAs following treatment of an ipsilateral knee or hip PJI, respectively. METHODS Using our institutional total joint registry, we identified 205 patients who underwent treatment for PJI (123 THAs and 83 TKAs) with an at-risk ipsilateral in situ knee or hip, respectively, between 2000 and 2019. In total, 54% of index PJIs were chronic and 46% were acute. The mean age was 70 years, 47% were female, and the mean body mass index was 32. Kaplan-Meier survivorship analyses were performed. Mean follow-up was 6 years. RESULTS The 5-year survivorship free of PJI in an at-risk THA after an ipsilateral TKA was treated for PJI was 97%. The 5-year survivorship free of PJI in an at-risk TKA when the ipsilateral THA was treated for PJI was 99%. Three PJIs occurred (2 THAs and 1 TKA), all over 1 year from the index ipsilateral PJI treatment. One hip PJI was an acute hematogenous infection that resulted from pneumonia. The other 2 new PJIs were caused by the same organism as the index PJI and were due to a failure of source control at the index joint. CONCLUSIONS When diagnosed with PJI in a single joint, the risk of developing PJI in an ipsilateral prosthetic joint within 5 years was low (1 to 3% risk). In the rare event of an ipsilateral infection, all occurred greater than one year from the index PJI and 2 of 3 were with the same organism when source infection control failed. LEVEL OF EVIDENCE Prognostic Level III.
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Affiliation(s)
| | - Harold I Salmons
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Prabin Thapa
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Aaron J Tande
- Division of Infectious Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | | | - Daniel J Berry
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Matthew P Abdel
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
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Gonzalez-Parreño S, Miralles-Muñoz FA, Martinez-Mendez D, Perez-Aznar A, Gonzalez-Navarro B, Lizaur-Utrilla A, Vizcaya-Moreno MF. Smoking is not closely related to revision for periprosthetic joint infection after primary total knee and hip arthroplasty. Orthop Traumatol Surg Res 2024; 110:103876. [PMID: 38582225 DOI: 10.1016/j.otsr.2024.103876] [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: 05/17/2023] [Revised: 09/21/2023] [Accepted: 03/27/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND The influence of smoking on the risk of periprosthetic joint infection (PJI) remains unclear. The objective was to explore the impact of smoking on PJI after primary total knee (TKA) and hip (THA) arthroplasty. HYPOTHESIS Current smoking patients should have an increased risk of PIJ compared with nonsmoking patients. PATIENTS AND METHODS A prospective registry-based observational cohort study was performed. A total of 4591 patients who underwent primary TKA (3076 patients) or THA (1515) were included. According to the smoking status at the time of arthroplasty, patients were classified as nonsmokers (3031 patients), ex-smokers (688), and smokers (872). Multivariate analysis included smoking status, age, gender, education level, body mass index, American Society of Anesthesiologists class, diagnosis (osteoarthritis, rheumatism), diabetes, chronic obstructive pulmonary disease, perioperative blood transfusion, site of arthroplasty (knee, hip), length of operation, and length of stay. RESULTS There were PJI after 59 (1.9%) TKA and 27 (1.8%) THA (p=0.840). There were PJI in 47 (1.6%) nonsmokers, 12 (1.7%) ex-smokers, and 17 (1.9%) smokers (p=0.413). There were wound complications (delayed wound healing and superficial wound infection) in 34 (0.7%) nonsmokers, 9 (1.3%) in ex-smokers, and 17 (1.9%) in smokers (p=0.045). In multivariate analysis, only the female gender was a significant predictor of PJI (OR 1.3, 95% CI 1.1-2.4 [p=0.039]). Specifically, the categories of ex-smokers (OR 0.8, 95% CI 0.2-1.7 [p=0.241]) and smokers (OR 1.1, 95% CI 0.6-1.5 [p=0.052]) were not significant predictors. The 4-year arthroplasty survival with PJI as the endpoint was 99.1% (95% CI: 99.0-99.7) for nonsmokers, 99.0% (95% CI: 98.8-99.2) for ex-smokers, and 98.7% (95% CI: 98.2-99.0) for smokers was not significantly different between smoking status groups (p=0.318). DISCUSSION Smoking was not identified as a significant predictor for PJI following primary TKA or THA. LEVEL OF EVIDENCE III, prospective cohort study.
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Affiliation(s)
- Santiago Gonzalez-Parreño
- Dpt. of Orthopaedic Surgery. Elda University Hospital, Ctra Elda-Sax s/n, 03600 Elda, Alicante, Spain
| | | | - Daniel Martinez-Mendez
- Dpt. of Orthopaedic Surgery. Elda University Hospital, Ctra Elda-Sax s/n, 03600 Elda, Alicante, Spain
| | - Adolfo Perez-Aznar
- Dpt. of Orthopaedic Surgery. Elda University Hospital, Ctra Elda-Sax s/n, 03600 Elda, Alicante, Spain
| | - Blanca Gonzalez-Navarro
- Dpt. of Orthopaedic Surgery. Elda University Hospital, Ctra Elda-Sax s/n, 03600 Elda, Alicante, Spain
| | - Alejandro Lizaur-Utrilla
- Dpt. of Orthopaedic Surgery. Elda University Hospital, Ctra Elda-Sax s/n, 03600 Elda, Alicante, Spain; Dpt. of Traumatology and Orthopaedics, Miguel Hernandez University, Avda Universidad s/n, 03202 San Juan de Alicante, Alicante, Spain.
| | - Maria Flores Vizcaya-Moreno
- Clinical Research Group, Faculty of Health Sciences, University of Alicante, Ctra San Vicente del Raspeig, s/n, 03690 San Vicente del Raspeig, Alicante, Spain
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Smolle MA, Fischerauer S, Vukic I, Wenzl FA, Leitner L, Leithner A, Sadoghi P. Readmissions at 30 Days and 1 Year for Implant-Associated Complications Following Primary Total Hip and Knee Arthroplasty: A Population-Based Study of 34,392 Patients Across Austria. J Arthroplasty 2024:S0883-5403(24)00871-4. [PMID: 39214482 DOI: 10.1016/j.arth.2024.08.027] [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: 01/12/2024] [Revised: 08/15/2024] [Accepted: 08/16/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND The primary aim of this study was to assess 30-day and 1-year rates for unplanned readmission due to implant-associated complications following total hip (THA) or total knee arthroplasty (TKA) in Austria. Secondary endpoints were reasons for readmission and differences in revision risk depending on demographics and hospital size. METHODS Data on patients receiving THA (n = 18,508) or TKA (n = 15,884) in orthopaedic and trauma units across Austria within a 1-year period (January 2021 to December 2021) were retrieved from a government-maintained database. The absolute and relative frequencies of unplanned readmissions were calculated. Risk factors for 30-day and 1-year readmission following THA or TKA due to implant-associated complications were investigated. RESULTS The 30-day and 1-year readmission rates for any implant-associated complication were 1.0% (339 of 34,392) and 3.0% (1,024 of 34,392), respectively. Relative to the overall readmission rate for any complication at 30 days (n = 1,952) and 1 year (n = 12,109), readmission rates for implant-associated complications were 17.4 and 8.5%, respectively. The 30-day readmission rates were higher in THA (1.2%) than TKA patients (0.8%; P = 0.001), while it was the opposite at 1 year (THA, 2.7%; TKA, 3.3%; P < 0.001). Mechanical complications (554 of 1,024) were the most common reason for 1-year readmission. Prolonged length of in-hospital stay independently associated with increased 1-year readmission risk in THA and TKA patients. Treatment at large-sized hospitals was associated with a higher 1-year readmission risk in TKA patients. CONCLUSIONS The 30-day and 1-year readmission rates for implant-associated complications following THA or TKA in Austria are lower than reported in other countries, with similar risk factors and reasons for readmission. Considering that almost 20% of unplanned hospital readmissions following total joint arthroplasty are attributable to implant-associated complications, optimization of in-hospital and postdischarge medical care for these patients is warranted.
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Affiliation(s)
- Maria A Smolle
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
| | - Stefan Fischerauer
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
| | - Ines Vukic
- Federal Ministry Republic of Austria, Social Affairs, Health, Care and Consumer Protection, Vienna, Austria
| | - Florian A Wenzl
- Center for Molecular Cardiology, University of Zürich, Schlieren, Switzerland; National Disease Registration and Analysis Service, NHS, London, United Kingdom; Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom; Department of Clinical Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Lukas Leitner
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria; Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), LMU University Hospital, Munich, Germany
| | - Andreas Leithner
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
| | - Patrick Sadoghi
- Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
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11
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Burch MA, Keshishian A, Wittmann C, Nehrbass D, Thompson K, Arens D, Richards RG, Mdingi V, Chitto M, Morgenstern M, Moriarty TF, Eijer H. Impact of Perioperative Dexamethasone Administration on Infection and Implant Osseointegration in a Preclinical Model of Orthopedic Device-Related Infection. Microorganisms 2024; 12:1134. [PMID: 38930516 PMCID: PMC11205448 DOI: 10.3390/microorganisms12061134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2024] [Revised: 05/27/2024] [Accepted: 05/29/2024] [Indexed: 06/28/2024] Open
Abstract
Glucocorticoids may be given prior to major orthopedic surgery to decrease postoperative nausea, vomiting, and pain. Additionally, many orthopedic patients may be on chronic glucocorticoid therapy. The aim of our study was to investigate whether glucocorticoid administration influences Orthopedic-Device-Related Infection (ODRI) in a rat model. Screws colonized with Staphylococcus epidermidis were implanted in the tibia of skeletally mature female Wistar rats. The treated groups received either a single shot of dexamethasone in a short-term risk study, or a daily dose of dexamethasone in a longer-term interference study. In both phases, bone changes in the vicinity of the implant were monitored with microCT. There were no statistically significant differences in bacteriological outcome with or without dexamethasone. In the interference study, new bone formation was statistically higher in the dexamethasone-treated group (p = 0.0005) as revealed by CT and histopathological analysis, although with relatively low direct osseointegration of the implant. In conclusion, dexamethasone does not increase the risk of developing periprosthetic osteolysis or infection in a pre-clinical model of ODRI. Long-term administration of dexamethasone seemed to offer a benefit in terms of new bone formation around the implant, but with low osseointegration.
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Affiliation(s)
- Marc-Antoine Burch
- AO Research Institute Davos, 7270 Davos, Switzerland; (M.-A.B.)
- Klinik für Orthopädie und Traumatologie, Universitätsspital Basel, 4031 Basel, Switzerland
| | - Aron Keshishian
- AO Research Institute Davos, 7270 Davos, Switzerland; (M.-A.B.)
- Spital Emmental, 3400 Burgdorf, Switzerland
| | | | - Dirk Nehrbass
- AO Research Institute Davos, 7270 Davos, Switzerland; (M.-A.B.)
| | - Keith Thompson
- AO Research Institute Davos, 7270 Davos, Switzerland; (M.-A.B.)
| | - Daniel Arens
- AO Research Institute Davos, 7270 Davos, Switzerland; (M.-A.B.)
| | | | - Vuysa Mdingi
- AO Research Institute Davos, 7270 Davos, Switzerland; (M.-A.B.)
- Department of Orthopaedic Surgery, Dr Pixley Ka Isaka Seme Memorial Hospital, School of Clinical Medicine, University of KwaZulu Natal, Durban 4041, South Africa
| | - Marco Chitto
- AO Research Institute Davos, 7270 Davos, Switzerland; (M.-A.B.)
| | - Mario Morgenstern
- Klinik für Orthopädie und Traumatologie, Universitätsspital Basel, 4031 Basel, Switzerland
- Center for Muskuloskeletal Infections (ZMSI), University Hospital Basel, 4031 Basel, Switzerland
| | - T. Fintan Moriarty
- AO Research Institute Davos, 7270 Davos, Switzerland; (M.-A.B.)
- Center for Muskuloskeletal Infections (ZMSI), University Hospital Basel, 4031 Basel, Switzerland
| | - Henk Eijer
- Spital Emmental, 3400 Burgdorf, Switzerland
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12
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Williams M, Harris RM. Efficacy of a Novel Intraoperative Surgical Irrigant in Preventing Periprosthetic Joint Infections in Primary Knee, Hip, and Shoulder Arthroplasties: A Retrospective Analysis. Orthop Surg 2024; 16:1277-1283. [PMID: 38627352 PMCID: PMC11144508 DOI: 10.1111/os.14052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 03/15/2024] [Accepted: 03/16/2024] [Indexed: 06/04/2024] Open
Abstract
OBJECTIVE Primary joint arthroplasty (JA) is one of the most common operating room (OR) procedures, with knee and hip arthroplasties being listed in the top five most frequent OR procedures and while not as common, shoulder arthroplasties are increasing at greater rates than knee and hip arthroplasties. Periprosthetic joint/shoulder infections (PJI/PSI) are a devastating complication of primary JAs with infection prevention deemed as the single most important strategy in combating them. The objective of this study was to retrospectively evaluate the efficacy of XPERIENCE® Advanced Surgical Irrigation (XP) in preventing PJI following primary joint arthroplasty. METHODS This is a retrospective study of primary knee, hip and shoulder arthroplasties that were performed by multiple orthopedic surgeons at a single hospital setting. XPERIENCE was used as an intraoperative surgical irrigant either solely, or with other intraoperative practices for prevention of infection. Incidence of acute PJI occurring within 90 days of index surgery were retrospectively collated. RESULTS Four hundred and twenty-three (423) primary joint replacement surgeries treated intraoperatively with XP, were evaluated for acute PJI incidence. Retrospective evaluations determined that 95% of the subjects had at least one risk factor predisposing them to PJI. There were zero PJIs diagnosed in the knee and hip arthroplasty cohorts and zero PSIs diagnosed in the shoulder arthroplasty cohorts. CONCLUSION The absence of PJI/PSI diagnoses in the JA cohorts treated intraoperatively with XP indicates that it could be an efficacious antimicrobial irrigant in preventing PJI, and warrants being evaluated in prospective, randomized controlled clinical trials as the sole intraoperative irrigant, as well as in combination with the other intraoperative infection prevention regimens evaluated in this retrospective study.
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MESH Headings
- Humans
- Retrospective Studies
- Prosthesis-Related Infections/prevention & control
- Male
- Female
- Therapeutic Irrigation/methods
- Aged
- Middle Aged
- Arthroplasty, Replacement, Shoulder/methods
- Intraoperative Care/methods
- Arthroplasty, Replacement, Knee/adverse effects
- Arthroplasty, Replacement, Knee/methods
- Arthroplasty, Replacement, Hip/methods
- Arthroplasty, Replacement, Hip/adverse effects
- Aged, 80 and over
- Adult
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Affiliation(s)
- Marshall Williams
- Jack Hughston Memorial HospitalPhenix CityALUSA
- Hughston FoundationColumbusGAUSA
| | - Robert M. Harris
- Quillen College of Medicine, East Tennessee State UniversityJohnson CityTNUSA
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13
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Tekin-Taş Z, Özger HS, Kanatlı U, Hızel K. The Incidence and Risk Factors of Early Periprosthetic Joint Infections. INFECTIOUS DISEASES & CLINICAL MICROBIOLOGY 2024; 6:93-101. [PMID: 39005702 PMCID: PMC11243772 DOI: 10.36519/idcm.2024.332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 04/08/2024] [Indexed: 07/16/2024]
Abstract
Objective Periprosthetic joint infections (PJI) represent major complications in arthroplasty, contributing to increased patient morbidity and imposing substantial financial burdens. Meticulous surveillance of PJI occurrences and identification of associated risk factors is imperative for accurately gauging the incidence rates and implementing proactive infection control measures. This study aimed to ascertain the early incidence of PJI and elucidate the key risk factors involved in its occurrence. Materials and Methods This monocentric, prospective descriptive study conducted between June 2018 and June 2019, including all patients aged 18 years and above who underwent hip and knee arthroplasty. The research documented and evaluated patient demographic characteristics, clinical findings, laboratory results, treatment practices, and potential risk factors associated with the surgical process. After the 90-day postoperative period, patients were categorized into PJI and non-PJI groups, allowing for a comprehensive comparison of identified risk factors. Results This study identified a cohort of 590 patients, of whom 185 underwent hip arthroplasties (31.4%) and 405 underwent knee arthroplasties (68.6%). The average age of the patients was 65.2 years, with females constituting 80.2% of the population. The overall incidence of early PJI was found to be 2.88% (n=17). Following hip arthroplasties, the PJI incidence was 4.86%, while knee arthroplasties exhibited a lower incidence of 1.9%. Several potential risk factors associated with PJI were identified, including comorbid diseases (adjusted odds ratio [aOR]=3.35, 95% confidence interval [CI]=1.18-9.47), preoperative length of stay (aOR=0.89, 95% CI=0.79-1.01), postoperative erythrocyte suspension replacement (aOR=1.96, 95% CI=0.71-5.44), and a National Nosocomial Infections Surveillance System (NNIS) score of 1 or higher (aOR=3.10, 95% CI=1.10-8.71). These factors were identified as potential contributors to the risk of PJI in patients undergoing hip and knee arthroplasties. Conclusion Compared to other reported outcomes in the literature, this study observed a higher incidence of early-stage PJI. The higher incidence may be due to PJI surveillance deficiencies such as difficulty in post-discharge surgical site infection (SSI) follow-up, reporting, and bacterial sampling. This discrepancy underscores the importance of actively monitoring patients with risk factors for PJI development, including medical comorbidities and a high NNIS score. Implementing prospective active surveillance in such cases is deemed crucial for the timely identification and management of PJI.
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Affiliation(s)
- Zeynep Tekin-Taş
- Department of Infectious Disease and Clinical Microbiology, Gazi University School of Medicine, Ankara, Türkiye
| | - Hasan Selçuk Özger
- Department of Infectious Disease and Clinical Microbiology, Gazi University School of Medicine, Ankara, Türkiye
| | - Ulunay Kanatlı
- Department of Orthopaedics and Traumatology, Gazi University School of Medicine, Ankara, Türkiye
| | - Kenan Hızel
- Department of Infectious Disease and Clinical Microbiology, Gazi University School of Medicine, Ankara, Türkiye
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14
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Perni S, Prokopovich P. Risk equations for prosthetic joint infections (PJIs) in UK: a retrospective study using the Clinical Practice Research Datalink (CPRD) AURUM and GOLD databases. BMJ Open 2024; 14:e082501. [PMID: 38719289 PMCID: PMC11086542 DOI: 10.1136/bmjopen-2023-082501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 04/26/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Prosthetic joint infections (PJIs) are a serious negative outcome of arthroplasty with incidence of about 1%. Risk of PJI could depend on local treatment policies and guidelines; no UK-specific risk scoring is currently available. OBJECTIVE To determine a risk quantification model for the development of PJI using electronic health records. DESIGN Records in Clinical Practice Research Datalink (CPRD) GOLD and AURUM of patients undergoing hip or knee arthroplasty between January 2007 and December 2014, with linkage to Hospital Episode Statistics and Office of National Statistics, were obtained. Cohorts' characteristics and risk equations through parametric models were developed and compared between the two databases. Pooled cohort risk equations were determined for the UK population and simplified through stepwise selection. RESULTS After applying the inclusion/exclusion criteria, 174 905 joints (1021 developed PJI) were identified in CPRD AURUM and 48 419 joints (228 developed PJI) in CPRD GOLD. Patients undergoing hip or knee arthroplasty in both databases exhibited different sociodemographic characteristics and medical/drug history. However, the quantification of the impact of such covariates (coefficients of parametric models fitted to the survival curves) on the risk of PJI between the two cohorts was not statistically significant. The log-normal model fitted to the pooled cohorts after stepwise selection had a C-statistic >0.7. CONCLUSIONS The risk prediction tool developed here could help prevent PJI through identifying modifiable risk factors pre-surgery and identifying the patients most likely to benefit from close monitoring/preventive actions. As derived from the UK population, such tool will help the National Health Service reduce the impact of PJI on its resources and patient lives.
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15
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Blackburn AZ, Ottesen TD, Katakam A, Bedair HS, Melnic CM. Mental Robustness May Be Associated With Improved Physical Function in Bilateral Total Knee Arthroplasty Patients. J Arthroplasty 2024; 39:1207-1213. [PMID: 37981110 DOI: 10.1016/j.arth.2023.11.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 11/09/2023] [Accepted: 11/09/2023] [Indexed: 11/21/2023] Open
Abstract
BACKGROUND In accordance with the high incidence of bilateral knee osteoarthritis, many patients have undergone bilateral total knee arthroplasty (BTKA). Whether patients undergo bilateral procedures in a staged or simultaneous fashion, the physical and mental burden of undergoing 2 major orthopedic procedures is considerable. The aims of this study were to (1) investigate differences between minimal clinically important difference (MCID) achievement between staged versus simultaneous BTKA, and (2) identify the patient variables, specifically mental scores, that were associated with MCID achievement in patients undergoing BTKA. METHODS Simultaneous and staged BTKA patients within a single health care network from 2016 to 2021 were retrospectively reviewed. Patient demographics, surgery details, and Patient-Reported Outcome Measurement Information System Physical Function Short Forms 10a (PROMIS PF10a), PROMIS Mental scores, and Knee Disability Osteoarthritis Outcome Scores (KOOS) were reviewed. Preoperative and postoperative patient-reported outcome measures were collected before the first total knee arthroplasty (TKA) and after the second TKA, respectively, in staged BTKA patients. The final cohort consisted of 249 patients, with an average age of 66 years (range, 21 to 87), 63% women, and an average body mass index of 32 (range, 20 to 52), at a mean follow-up of 1.1 years (range, 0.5 to 2.4). Multivariate regressions were performed on MCID PF10a and KOOS achievement, as well as whether the BTKA was performed simultaneously versus staged. RESULTS A preoperative PROMIS Mental score in the upper 2 quartiles was associated with MCID PF10a achievement in BTKA. Men and surgeries performed at an Academic Medical Center were negatively associated with the achievement of MCID KOOS. Interestingly, those who underwent simultaneous BTKA were less likely to achieve MCID KOOS than those who underwent a staged BTKA. CONCLUSIONS Preoperative mental robustness may be positively associated with improved physical function outcome in BTKA patients.
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Affiliation(s)
- Amy Z Blackburn
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Newton, Massachusetts
| | - Taylor D Ottesen
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Akhil Katakam
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Newton, Massachusetts
| | - Hany S Bedair
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Newton, Massachusetts
| | - Christopher M Melnic
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Newton, Massachusetts
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16
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De Mauro D, Meschini C, Balato G, Ascione T, Festa E, Bizzoca D, Moretti B, Maccauro G, Vitiello R. Sex-related differences in periprosthetic joint infection research. J Bone Jt Infect 2024; 9:137-142. [PMID: 38895102 PMCID: PMC11184614 DOI: 10.5194/jbji-9-137-2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 03/06/2024] [Indexed: 06/21/2024] Open
Abstract
Introduction: Periprosthetic joint infections (PJIs) have emerged as a focal point in the realm of orthopedics, garnering widespread attention owing to the escalating incidence rates and the profound impact they impose on patients undergoing total joint arthroplasties (TJAs). Year after year, there has been a growing trend in the analysis of multiple risk factors, complication rates, and surgical treatments in the field. This study aims to illuminate the status of the sex-related differences in periprosthetic joint infections and advance research in this field. Methods: A systematic review was carried out following the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. The final reference list comprised longitudinal studies (both retrospective and prospective) and randomized controlled trials. A sex-based analysis was conducted to assess differences between males and females. Results: A total of 312 studies were initially identified through online database searches and reference investigations. Nine studies were subsequently included in the review. Eight out of nine studies examined the risk of developing PJI after total joint replacement. Notably, only half of these studies demonstrated a statistically significant value, with a p value < 0.05 , indicating a higher risk of infectious complications in males compared to females. Conclusion: According to the current literature, there appears to be a propensity for males to develop periprosthetic joint infection after total joint arthroplasty at a higher rate than the female population. Enhancing sex-related analysis in this field is imperative for gathering more robust evidence and insights.
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Affiliation(s)
- Domenico De Mauro
- Department of Orthopedics and Rheumatological Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Department of Orthopedics and Geriatric Sciences, Catholic University of the Sacred Heart, Rome, Italy
- Orthopedics and Traumatology Unit, Department of Public Health, Orthopedic Unit, “Federico II” University, Naples, Italy
| | - Cesare Meschini
- Department of Orthopedics and Rheumatological Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Department of Orthopedics and Geriatric Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Giovanni Balato
- Orthopedics and Traumatology Unit, Department of Public Health, Orthopedic Unit, “Federico II” University, Naples, Italy
| | - Tiziana Ascione
- Service of Infectious Diseases, AORN Antonio Cardarelli Hospital, Naples, Italy
| | - Enrico Festa
- Orthopedics and Traumatology Unit, Department of Public Health, Orthopedic Unit, “Federico II” University, Naples, Italy
| | - Davide Bizzoca
- Orthopedics and Traumatology Unit, UOSD Vertebral Surgery, AOU Consorziale “Policlinico”, Bari, Italy
| | - Biagio Moretti
- Orthopedics and Traumatology Unit, UOSD Vertebral Surgery, AOU Consorziale “Policlinico”, Bari, Italy
| | - Giulio Maccauro
- Department of Orthopedics and Rheumatological Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Department of Orthopedics and Geriatric Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Raffaele Vitiello
- Department of Orthopedics and Rheumatological Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Department of Orthopedics and Geriatric Sciences, Catholic University of the Sacred Heart, Rome, Italy
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MacConnell AE, Levack AE, Brown NM. Biofilm and How It Relates to Prosthetic Joint Infection. Orthop Clin North Am 2024; 55:161-169. [PMID: 38403363 DOI: 10.1016/j.ocl.2023.10.001] [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] [Indexed: 02/27/2024]
Abstract
Prosthetic joint infection following total joint arthroplasty is a devastating complication, resulting in increased morbidity and mortality for the patient. The formation of a biofilm on implanted hardware contributes to the difficulty in successful identification and eradication of the infection. Antibiotic therapy and surgical intervention are necessary for addressing this condition; we present a discussion on different treatment options, including those that are not yet routinely utilized in the clinical setting or are under investigation, to highlight the present and future of PJI management.
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Affiliation(s)
- Ashley E MacConnell
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, 2160 South First Avenue, Suite 1700, Maywood, IL 60153, USA.
| | - Ashley E Levack
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, 2160 South First Avenue, Suite 1700, Maywood, IL 60153, USA
| | - Nicholas M Brown
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, 2160 South First Avenue, Suite 1700, Maywood, IL 60153, USA
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18
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Reynolds AW, Vallès KF, Wang DX, Vyas P, Regal S, Garay M. Dyslipidaemia is associated with Cutibacterium acnes hip and knee prosthetic joint infection. INTERNATIONAL ORTHOPAEDICS 2024; 48:899-904. [PMID: 38157039 DOI: 10.1007/s00264-023-06066-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 12/09/2023] [Indexed: 01/03/2024]
Abstract
PURPOSE Optimization of medical factors including diabetes and obesity is a cornerstone in the prevention of prosthetic joint infection (PJI). Dyslipidaemia is another component of metabolic syndrome which has not been thoroughly investigated as an individual, modifiable risk factor. This study examined the association of dyslipidaemia with PJI caused by the lipophilic microbe Cutibacterium acnes (C. acnes). METHODS A retrospective chart review examined patients with positive C. acnes culture at hip or knee arthroplasty explantation. A control group with methicillin-sensitive Staphylococcus aureus (MSSA) positive cultures at explantation was matched for age, sex, and surgical site, as well as a second control group with no infection. A total of 80 patients were included, 16 with C. acnes, 32 with MSSA, and 32 with no infection. All patients had a lipid panel performed within one year of surgery. Lipid values and categories were compared using multinomial logistic regressions. RESULTS High or borderline triglycerides (TG) (relative risk ratio (RRR) = 0.13; P = 0.013) and low high-density lipoprotein (HDL) (RRR = 0.13; P = 0.025) were significantly associated with C. acnes PJI compared to MSSA-PJI. High or borderline TG (RRR = 0.21; P = 0.041) and low HDL (RRR = 0.17; P = 0.043) were also associated with a greater probability of C. acnes infection compared to no infection. CONCLUSIONS The presence of elevated TG and low HDL were both associated at a statistically significant level with C. acnes hip or knee PJI compared to controls with either MSSA PJI or no infection. This may represent a specific risk factor for C. acnes PJI that is modifiable.
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Affiliation(s)
- Alan W Reynolds
- Allegheny Health Network, 1307 Federal St, Pittsburgh, PA, 15212, USA.
| | | | - David X Wang
- Allegheny Health Network, 1307 Federal St, Pittsburgh, PA, 15212, USA
| | - Praveer Vyas
- Allegheny Health Network, 1307 Federal St, Pittsburgh, PA, 15212, USA
| | - Steven Regal
- Allegheny Health Network, 1307 Federal St, Pittsburgh, PA, 15212, USA
| | - Mariano Garay
- Allegheny Health Network, 1307 Federal St, Pittsburgh, PA, 15212, USA
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Onorato F, Masoni V, Gagliardi L, Comba LC, Rivera F. What to Know about Antimicrobial Coatings in Arthroplasty: A Narrative Review. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:574. [PMID: 38674220 PMCID: PMC11052078 DOI: 10.3390/medicina60040574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Revised: 03/27/2024] [Accepted: 03/28/2024] [Indexed: 04/28/2024]
Abstract
Periprosthetic joint infections (PJIs) are one of the most worrying complications orthopedic surgeons could face; thus, methods to prevent them are evolving. Apart from systemic antibiotics, targeted strategies such as local antimicrobial coatings applied to prosthetics have been introduced. This narrative review aims to provide an overview of the main antimicrobial coatings available in arthroplasty orthopedic surgery practice. The search was performed on the PubMed, Web of Science, SCOPUS, and EMBASE databases, focusing on antimicrobial-coated devices used in clinical practice in the arthroplasty world. While silver technology has been widely adopted in the prosthetic oncological field with favorable outcomes, recently, silver associated with hydroxyapatite for cementless fixation, antibiotic-loaded hydrogel coatings, and iodine coatings have all been employed with promising protective results against PJIs. However, challenges persist, with each material having strengths and weaknesses under investigation. Therefore, this narrative review emphasizes that further clinical studies are needed to understand whether antimicrobial coatings can truly revolutionize the field of PJIs.
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Affiliation(s)
- Francesco Onorato
- Department of Orthopedics and Traumatology, University of Turin, Via Zuretti, 29, 10126 Turin, Italy; (F.O.); (V.M.); (L.G.)
| | - Virginia Masoni
- Department of Orthopedics and Traumatology, University of Turin, Via Zuretti, 29, 10126 Turin, Italy; (F.O.); (V.M.); (L.G.)
| | - Luca Gagliardi
- Department of Orthopedics and Traumatology, University of Turin, Via Zuretti, 29, 10126 Turin, Italy; (F.O.); (V.M.); (L.G.)
- Department of Orthopedics and Traumatology, Ospedale SS Annunziata, ASL CN1, Via Ospedali, 9, 12038 Savigliano, Italy;
| | - Luca Costanzo Comba
- Department of Orthopedics and Traumatology, Ospedale SS Annunziata, ASL CN1, Via Ospedali, 9, 12038 Savigliano, Italy;
| | - Fabrizio Rivera
- Department of Orthopedics and Traumatology, Ospedale SS Annunziata, ASL CN1, Via Ospedali, 9, 12038 Savigliano, Italy;
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20
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Li H, Zheng Q, Niu E, Xu J, Chai W, Xu C, Fu J, Hao L, Chen J, Zhang G. Increased risk of periprosthetic joint infection after traumatic injury in joint revision patients. ARTHROPLASTY 2024; 6:8. [PMID: 38311788 PMCID: PMC10840204 DOI: 10.1186/s42836-024-00235-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 01/04/2024] [Indexed: 02/06/2024] Open
Abstract
BACKGROUND Periprosthetic joint infection (PJI) is a serious complication after total joint arthroplasty (TJA). Although some risk factors of PJI were well studied, the association between trauma and PJI remains unknown in revision patients. MATERIALS AND METHODS Between 2015 and 2018, a total of 71 patients with trauma history before revisions (trauma cohort) were propensity score matched (PSM) at a ratio of 1 to 5 with a control cohort of revision patients without a history of trauma. Then, the cumulative incidence rate of PJI within 3 years after operation between the two groups was compared. The secondary endpoints were aseptic revisions within 3 postoperative years, complications up to 30 postoperative days, and readmission up to 90 days. During a minimal 3-year follow-up, the survival was comparatively analyzed between the trauma cohort and the control cohort. RESULTS The cumulative incidence of PJI was 40.85% in patients with trauma history against 27.04% in the controls (P = 0.02). Correspondingly, the cumulative incidence of aseptic re-revisions was 12.68% in patients with trauma history compared with 5.07% in the control cohort (P = 0.028). Cox regression revealed that trauma history was a risk factor of PJI (HR, 1.533 [95%CI, (1.019,2.306)]; P = 0.04) and aseptic re-revisions (HR, 3.285 [95%CI, (1.790,6.028)]; P < 0.0001). CONCLUSIONS Our study demonstrated that revision patients with trauma history carried a higher risk of PJI compared to those without trauma history. Moreover, after revisions, the trauma patients were still at higher risk for treatment failure due to PJI, periprosthetic joint fracture, and mechanical complications.
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Affiliation(s)
- Hao Li
- Medical School of Chinese PLA, Beijing, 100853, China
- Department of Orthopedic Surgery, First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China
- Senior Department of Orthopedics, Fourth Medical Center, Chinese PLA General Hospital, Beijing, 100048, China
| | - Qingyuan Zheng
- Medical School of Chinese PLA, Beijing, 100853, China
- Department of Orthopedic Surgery, First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China
- Senior Department of Orthopedics, Fourth Medical Center, Chinese PLA General Hospital, Beijing, 100048, China
| | - Erlong Niu
- Department of Orthopedics, Fifth Medical Center, Chinese PLA General Hospital, Beijing, 100039, China
| | - Jiazheng Xu
- Medical School of Chinese PLA, Beijing, 100853, China
- Department of Orthopedic Surgery, First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China
- Senior Department of Orthopedics, Fourth Medical Center, Chinese PLA General Hospital, Beijing, 100048, China
| | - Wei Chai
- Department of Orthopedic Surgery, First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China
- Senior Department of Orthopedics, Fourth Medical Center, Chinese PLA General Hospital, Beijing, 100048, China
| | - Chi Xu
- Department of Orthopedic Surgery, First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China
- Senior Department of Orthopedics, Fourth Medical Center, Chinese PLA General Hospital, Beijing, 100048, China
| | - Jun Fu
- Department of Orthopedic Surgery, First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China
- Senior Department of Orthopedics, Fourth Medical Center, Chinese PLA General Hospital, Beijing, 100048, China
| | - Libo Hao
- Department of Orthopedic Surgery, First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China
- Senior Department of Orthopedics, Fourth Medical Center, Chinese PLA General Hospital, Beijing, 100048, China
| | - Jiying Chen
- Department of Orthopedic Surgery, First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China.
- Senior Department of Orthopedics, Fourth Medical Center, Chinese PLA General Hospital, Beijing, 100048, China.
| | - Guoqiang Zhang
- Department of Orthopedic Surgery, First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China.
- Senior Department of Orthopedics, Fourth Medical Center, Chinese PLA General Hospital, Beijing, 100048, China.
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21
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Bettinger JJ, Friedman BC. Opioids and Immunosuppression: Clinical Evidence, Mechanisms of Action, and Potential Therapies. Palliat Med Rep 2024; 5:70-80. [PMID: 38435086 PMCID: PMC10908329 DOI: 10.1089/pmr.2023.0049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2023] [Indexed: 03/05/2024] Open
Abstract
Background In addition to the more well-known adverse effects of opioids, such as constipation, mounting evidence supports underlying immunosuppressive effects as well. Methods In this study, we provide a narrative review of preclinical and clinical evidence of opioid suppression of the immune system as well as possible considerations for therapies. Results In vitro and animal studies have shown clear effects of opioids on inflammatory cytokine expression, immune cell activity, and pathogen susceptibility. Observational data in humans have so far supported preclinical findings, with multiple reports of increased rates of infections in various settings of opioid use. However, the extent to which this risk is due to the impact of opioids on the immune system compared with other risk factors associated with opioid use remains uncertain. Considering the data showing immunosuppression and increased risk of infection with opioid use, measures are needed to mitigate this risk in patients who require ongoing treatment with opioids. In preclinical studies, administration of opioid receptor antagonists blocked the immunomodulatory effects of opioids. Conclusions As selective antagonists of peripheral opioid receptors, peripherally acting mu-opioid receptor (MOR) antagonists may be able to protect against immune impairment while still allowing for opioid analgesia. Future research is warranted to further investigate the relationship between opioids and infection risk as well as the potential application of peripherally acting MOR antagonists to counteract these risks.
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Affiliation(s)
- Jeffrey J. Bettinger
- Pain Management, Saratoga Hospital Medical Group, Saratoga Springs, New York, USA
| | - Bruce C. Friedman
- JM Still Burn Center, Doctors Hospital of Augusta, Augusta, Georgia, USA
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22
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Tiwari V, Shendre P, Nag S, Mishra M, Roy M, Dwidmuthe S. Peri-prosthetic Joint Infection due to Candida albicans in a Young Immunocompetent Patient - A Rare Case Report. J Orthop Case Rep 2024; 14:160-164. [PMID: 38420226 PMCID: PMC10898703 DOI: 10.13107/jocr.2024.v14.i02.4256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 12/23/2023] [Indexed: 03/02/2024] Open
Abstract
Introduction The recent surge in joint replacement surgeries in India, particularly total knee and hip replacements, is notable. The majority of patients undergoing these procedures suffered from knee osteoarthritis or femoral head avascular necrosis. However, this increase in joint replacements has also led to a rise in periprosthetic joint infections (PJI), a severe and costly complication. PJI is responsible for 25% of total knee arthroplasty failures and 15% of total hip arthroplasty failures. Various risk factors, such as diabetes, fractures, and arthritis, are associated with PJI development. Bacterial infections, notably Staphylococcus species, are the primary cause of PJI, but rare fungal infections are often caused by Candida and Aspergillus. There is a lack of clinical trials and limited knowledge about the prevalence and treatment of fungal PJIs. Case Report This report presents a unique case of delayed PJI caused by Candida albicans in an otherwise healthy patient. Conclusion This case report emphasizes the need for further research and standardized treatment guidelines. Treatment typically involves a two-stage revision with extended antifungal therapy. The optimal duration of antifungal treatment remains uncertain.
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Affiliation(s)
- Vivek Tiwari
- Department of Orthopaedics and Joint Replacement, Apollo Sage Hospital, Bhopal, Madhya Pradesh, India
| | - Pooja Shendre
- Department of Microbiology, AIIMS Nagpur, Nagpur, Maharashtra, India
| | - Soumyabrata Nag
- Department of Microbiology, AIIMS Nagpur, Nagpur, Maharashtra, India
| | - Meena Mishra
- Department of Microbiology, AIIMS Nagpur, Nagpur, Maharashtra, India
| | - Mainak Roy
- Department of Orthopaedics, AIIMS Nagpur, Nagpur, Maharashtra, India
| | - Samir Dwidmuthe
- Department of Orthopaedics, AIIMS Nagpur, Nagpur, Maharashtra, India
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23
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Garcia AR, Ling K, Olsen E, Komatsu DE, Paulus M. Chronic Steroid Use Does Not Increase the Risk of Superficial Surgical Site Infection or Wound Dehiscence Following Total Ankle Arthroplasty. Cureus 2024; 16:e52569. [PMID: 38371139 PMCID: PMC10874611 DOI: 10.7759/cureus.52569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2024] [Indexed: 02/20/2024] Open
Abstract
Introduction Total ankle arthroplasty (TAA) is an effective treatment for end-stage ankle arthritis. Recent surgical and technological advances have led to a significant increase in the surgical volume of TAA. While a majority of ankle arthritis is post-traumatic in nature, other causes include autoimmune or inflammatory conditions. Medical management of these conditions frequently requires chronic corticosteroid administration, which is a well-established risk factor for complications following surgery. The purpose of this study was to investigate the association between chronic preoperative steroid use and postoperative complications following TAA. Methods The American College of Surgeons National Surgical Quality Improvement (NSQIP) database was analyzed to identify all patients who underwent TAA between 2015 and 2020. Patient characteristics including demographics, comorbidities, surgical characteristics, and 30-day postoperative complication data were collected. The data was analyzed using bivariate and multivariate logistic regression to identify all postoperative complications associated with chronic preoperative steroid use. Results A total of 1,606 patients were included in this study: 1,533 (95.5%) were included in the non-steroid cohort, and 73 (4.5%) were included in the chronic steroid cohort. Chronic steroid use was significantly associated with female sex (p < 0.001) and American Society of Anesthesiologists (ASA) ≥3 (p < 0.001). Chronic steroid use was not associated with superficial surgical site infection (SSI) (p = 0.634) or wound dehiscence (p = 0.999). The postoperative complication that was significantly associated with chronic steroid use was sepsis (p = 0.031). After adjusting for female sex and the ASA grade, chronic steroid use was found to be independently associated with sepsis (p = 0.013). Conclusion Preoperative chronic steroid use is not associated with superficial SSI or wound dehiscence within 30 days following TAA. As TAA becomes a more attractive alternative to ankle arthrodesis, a better understanding of preoperative risk factors can aid in widening indications and knowing what patients are at risk for complications.
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Affiliation(s)
| | - Kenny Ling
- Orthopaedic Surgery, Stony Brook University, New York, USA
| | - Evan Olsen
- Orthopaedic Surgery, Stony Brook University, New York, USA
| | | | - Megan Paulus
- Orthopaedic Surgery, Stony Brook University, New York, USA
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24
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Piuzzi NS, Klika AK, Lu Q, Higuera-Rueda CA, Stappenbeck T, Visperas A. Periprosthetic joint infection and immunity: Current understanding of host-microbe interplay. J Orthop Res 2024; 42:7-20. [PMID: 37874328 DOI: 10.1002/jor.25723] [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: 05/31/2023] [Revised: 09/19/2023] [Accepted: 10/17/2023] [Indexed: 10/25/2023]
Abstract
Periprosthetic joint infection (PJI) is a major complication of total joint arthroplasty. Even with current treatments, failure rates are unacceptably high with a 5-year mortality rate of 26%. Majority of the literature in the field has focused on development of better biomarkers for diagnostics and treatment strategies including innovate antibiotic delivery systems, antibiofilm agents, and bacteriophages. Nevertheless, the role of the immune system, our first line of defense during PJI, is not well understood. Evidence of infection in PJI patients is found within circulation, synovial fluid, and tissue and include numerous cytokines, metabolites, antimicrobial peptides, and soluble receptors that are part of the PJI diagnosis workup. Macrophages, neutrophils, and myeloid-derived suppressor cells (MDSCs) are initially recruited into the joint by chemokines and cytokines produced by immune cells and bacteria and are activated by pathogen-associated molecular patterns. While these cells are efficient killers of planktonic bacteria by phagocytosis, opsonization, degranulation, and recruitment of adaptive immune cells, biofilm-associated bacteria are troublesome. Biofilm is not only a physical barrier for the immune system but also elicits effector functions. Additionally, bacteria have developed mechanisms to evade the immune system by inactivating effector molecules, promoting killing or anti-inflammatory effector cell phenotypes, and intracellular persistence and dissemination. Understanding these shortcomings and the mechanisms by which bacteria can subvert the immune system may open new approaches to better prepare our own immune system to combat PJI. Furthermore, preoperative immune system assessment and screening for dysregulation may aid in developing preventative interventions to decrease PJI incidence.
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Affiliation(s)
- Nicolas S Piuzzi
- Department of Orthopaedic Surgery, Cleveland Clinic Adult Reconstruction Research (CCARR), Cleveland Clinic, Cleveland, Ohio, USA
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, Ohio, USA
| | - Alison K Klika
- Department of Orthopaedic Surgery, Cleveland Clinic Adult Reconstruction Research (CCARR), Cleveland Clinic, Cleveland, Ohio, USA
| | - Qiuhe Lu
- Department of Inflammation and Immunity, Cleveland Clinic, Cleveland, Ohio, USA
| | | | | | - Anabelle Visperas
- Department of Orthopaedic Surgery, Cleveland Clinic Adult Reconstruction Research (CCARR), Cleveland Clinic, Cleveland, Ohio, USA
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25
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Jeong S, Lee JW, Boucher HR. Symptomatic Benign Prostatic Hyperplasia Is Not Associated With a Higher Risk of Periprosthetic Joint Infections and Periprosthetic Joint Infection-related Revisions After Primary THA. Clin Orthop Relat Res 2024; 482:89-95. [PMID: 37458699 PMCID: PMC10723855 DOI: 10.1097/corr.0000000000002766] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 05/12/2023] [Accepted: 06/08/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND Symptomatic benign prostatic hyperplasia (sBPH) is a potential risk factor for periprosthetic joint infection (PJI), a leading cause of implant failure and revision THA. However, the available evidence is mixed on whether this is the case. QUESTIONS/PURPOSES (1) What is the prevalence of sBPH in male recipients of primary THA by age group? (2) Do patients with sBPH compared with those without sBPH have higher 30-day, 90-day, and 2-year odds of PJI and higher 30-day and 90-day odds of urinary catheterization, urinary tract infection (UTI), and sepsis after primary THA? (3) Do patients with sBPH compared with those without sBPH have lower survivorship free from PJI-related revision at 5 years after THA? METHODS The PearlDiver database was used as it provided the largest sample of patients across all payer types to perform longitudinal research. Between January 2010 and April 2021, 1,056,119 patients who underwent primary THA were identified. After applying the inclusion criteria (that is, male sex, minimum age of 18, and diagnosis of hip osteoarthritis) and exclusion criteria (that is, history of asymptomatic BPH or any other joint arthroplasty), 16% (172,866) of patients remained. A further 6% (59,500) of patients were excluded as they did not meet the minimum study follow-up of 2 years, leaving 11% (113,366) for analysis. Of those, patients with sBPH were matched to those without in a 1:4 ratio by age and comorbidities, including alcohol abuse, anemia, cardiovascular disorders, chronic pulmonary disease, diabetes mellitus, depression, obesity, peripheral vascular disorders, renal failure, and rheumatoid arthritis. Age and comorbidities of the two groups postmatch were balanced. Logistic regression was performed to analyze the odds for 30-day, 90-day, and 2-year postoperative complications. Survivorship free from PJI-related revision at 5 years after THA was estimated using the Kaplan-Meier method and compared with the log-rank test. RESULTS Among male recipients of primary THA ages 65 or older, 24% (11,319 of 47,426) had a medical history of sBPH. We found no difference in the odds of PJI at 30 days, 90 days, and 2 years after primary THA between the two groups. PJI occurred in 0.5% (62 of 11,819), 0.8% (97 of 11,819), and 1.3% (150 of 11,819) of patients with sBPH versus in 0.5% (227 of 47,103), 0.8% (360 of 47,103), and 1.2% (570 of 47,103) of those without sBPH within 30 days (OR 1.09 [95% CI 0.82 to 1.43]), 90 days (OR 1.07 [95% CI 0.85 to 1.34]), and 2 years (OR 1.05 [95% CI 0.87 to 1.25]) after THA, respectively. Patients with sBPH compared with those without had higher odds of 30-day and 90-day urinary catheterization (OR 5.00 [95% CI 3.64 to 6.88] and OR 5.36 [95% CI 4.04 to 7.13], respectively), 30-day and 90-day UTI (OR 2.18 [95% CI 1.88 to 2.54] and OR 2.55 [95% CI 2.26 to 2.87], respectively), and 30-day and 90-day sepsis (OR 1.55 [95% CI 1.11 to 2.13] and OR 1.43 [95% CI 1.10 to 1.83], respectively). We found no difference in survival free from PJI-related revision at 5 years after THA between patients with and without sBPH (98.3% [95% CI 98.1% to 98.6%] versus 98.1% [95% CI 98.1% to 98.2%]; p = 0.10). CONCLUSION sBPH is common among THA recipients, and surgeons should be aware of the added risk of postoperative urinary complications and sepsis in this subset that could lead to additional postoperative care requirements. Surgeons may consider perioperative measures such as preoperative use of short-form questionnaires to assess urinary symptoms, urology clearance or referral, and closer follow-up to improve care of sBPH patients undergoing THA. As currently available tools for assessing sBPH are limited and lack sensitivity as well as specificity, future studies may develop validated tools that can be used to quickly assess risk in sBPH patients before surgery. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Suin Jeong
- Medstar Georgetown University, Washington, DC, USA
| | - Ji Won Lee
- MedStar Union Memorial Hospital, Baltimore, MD, USA
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26
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Salman LA, Hantouly AT, Khatkar H, Al-Ani A, Abudalou A, Al-Juboori M, Ahmed G. The outcomes of total hip replacement in osteonecrosis versus osteoarthritis: a systematic review and meta-analysis. INTERNATIONAL ORTHOPAEDICS 2023; 47:3043-3052. [PMID: 36905418 PMCID: PMC10673986 DOI: 10.1007/s00264-023-05761-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 03/02/2023] [Indexed: 03/12/2023]
Abstract
PURPOSE This systematic review and meta-analysis aimed to compare the outcomes of THA in patients with osteonecrosis (ON) and those with osteoarthritis (OA). METHODS Four databases were searched from inception till December 2022 for original studies that compared the outcomes of THA in ON and OA. The primary outcome was the revision rate; the secondary outcomes were dislocation and Harris hip score. This review was conducted in line with PRISMA guidelines, and the risk of bias was assessed using the Newcastle-Ottawa scale. RESULTS A total of 14 observational studies with 2,111,102 hips were included, with a mean age of 50.83 ± 9.32 and 55.51 ± 8.95 for ON and OA groups, respectively. The average follow-up was 7.25 ± 4.6 years. There was a statistically significant difference in revision rate between ON and OA patients in favour of OA (OR: 1.576; 95%CI: 1.24-2.00; p-value: 0.0015). However, dislocation rate (OR: 1.5004; 95%CI: 0.92-2.43; p-value: 0.0916) and Haris hip score (HHS) (SMD: - 0.0486; 95%CI: - 0.35-0.25; p-value: 0.6987) were comparable across both groups. Further sub-analysis adjusting for registry data also showed similar results between both groups. CONCLUSION A higher revision rate, periprosthetic fracture and periprosthetic joint infection following total hip arthroplasty were associated with osteonecrosis of the femoral head compared with osteoarthritis. However, both groups had similar dislocation rates and functional outcome measures. This finding should be applied in context due to potential confounding factors, including patient's age and activity level.
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Affiliation(s)
- Loay A Salman
- Orthopedics Department, Hamad General Hospital, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Windmill Road, Oxford, OX3 7LD, UK
| | - Ashraf T Hantouly
- Orthopedics Department, Hamad General Hospital, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | - Harman Khatkar
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Windmill Road, Oxford, OX3 7LD, UK
- Royal London Hospital, Whitechapel, London, UK
| | - Abdallah Al-Ani
- Office of Scientific Affairs and Research, King Hussein Cancer Center, Amman, Jordan
| | - Abedallah Abudalou
- Orthopedics Department, Hamad General Hospital, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | - Mohammed Al-Juboori
- Orthopedics Department, Hamad General Hospital, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | - Ghalib Ahmed
- Orthopedics Department, Hamad General Hospital, Hamad Medical Corporation, PO Box 3050, Doha, Qatar.
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27
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Kim SH, Jang SY, Cha Y, Kim BY, Lee HJ, Kim GO. Analysis of the effects of intraoperative warming devices on surgical site infection in elective hip arthroplasty using a large nationwide database. Arch Orthop Trauma Surg 2023; 143:7237-7244. [PMID: 37500931 DOI: 10.1007/s00402-023-04917-8] [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: 02/20/2023] [Accepted: 05/21/2023] [Indexed: 07/29/2023]
Abstract
INTRODUCTION The aim of our study is to analyze the association of usage and type of warming device with the risk of surgical site infection (SSI) in patients who underwent hip arthroplasty, and to analyze the factors that increase the risk of SSI if the warming device is not used. MATERIALS AND METHODS This retrospective cross-sectional study identified subjects from data of "Evaluation of the Appropriate Use of Prophylactic Antibiotics". Included patients were defined as those who underwent elective unilateral hip hemiarthroplasty or total hip arthroplasty (THA). Patients were classified into no intraoperative warming device, forced air warming devices, and devices using conduction. Multiple logistic regression analysis was conducted to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CIs) to assess the association between warming devices and SSI. RESULTS A total of 3945 patients met the inclusion criteria. Compared to those who received an intraoperative warming device, the odds of developing SSI were 1.9 times higher in those who did not receive intraoperative warming devices (aOR 1.9; 95% CI 1.1-3.6). The risk of SSI was 2.2 times higher with forced air warming devices compared to devices using conduction but this difference was not statistically significant (aOR 2.2; 95% CI 0.7-6.8). The risk of SSI increased in males (aOR 2.8; 95% CI 1.1-7.2), in patients under 70 years of age (aOR 4.4; 95% CI 1.6-10.4), in patients with a Charlson`s comorbidity index of 2 or higher (aOR 3.3; 95% CI 1.3-8.7), and in patients who underwent THA (aOR 3.8; 95% CI 1.7-8.3) when intraoperative warming devices were not used. CONCLUSIONS The use of intraoperative active warming devices is highly recommended to prevent SSI during elective hip arthroplasty. In particular, male patients younger than 70 years, those with a high CCI, and those undergoing THA are at significantly increased risk of SSI if intraoperative active warming devices are not used. Intraoperative warming device using conduction is likely superior to forced air warming device, but further studies are needed to confirm this.
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Affiliation(s)
- Seung Hoon Kim
- Department of Preventive Medicine, Eulji University School of Medicine, Daejeon, South Korea
| | - Suk-Yong Jang
- Department of Healthcare Management, Graduate School of Public Health, Yonsei University, Seoul, South Korea
| | - Yonghan Cha
- Department of Orthopaedic Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, 95 Dunsan Seoro, Seo-Gu, Daejeon, 35233, South Korea.
| | - Bo-Yeon Kim
- Healthcare Review and Assessment Committee, Health Insurance Review and Assessment Service, Wonju, South Korea
| | - Hyo-Jung Lee
- Quality Assessment Department, Health Insurance Review and Assessment Service, Wonju, South Korea
| | - Gui-Ok Kim
- Quality Assessment Department, Health Insurance Review and Assessment Service, Wonju, South Korea
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Schatz C, Plötz W, Beckmann J, Bredow K, Leidl R, Buschner P. Associations of preoperative anemia and postoperative hemoglobin values with hospital costs in total knee arthroplasty (TKA). Arch Orthop Trauma Surg 2023; 143:6741-6751. [PMID: 37306776 PMCID: PMC10258736 DOI: 10.1007/s00402-023-04929-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 05/22/2023] [Indexed: 06/13/2023]
Abstract
BACKGROUND Total knee arthroplasty are among the most frequently conducted surgeries, due to an aging society. Since hospital costs are subsequently rising, adequate preparation of patients and reimbursement becomes more and more important. Recent literature revealed anemia as a risk factor for enhanced length of stay (LOS) and complications. This study analyzed whether preoperative hemoglobin (Hb) and postoperative Hb were associated with total hospital costs and general ward costs. METHODS The study comprised 367 patients from a single high-volume hospital in Germany. Hospital costs were calculated with standardized cost accounting methods. Generalized linear models were applied to account for confounders, such as age, comorbidities, body mass index, insurance status, health-related quality of life, implant types, incision-suture-time and tranexamic acid. RESULTS Preoperative anemic women had 426 Euros higher general ward costs (p < 0.01), due to increased LOS. For men, 1 g/dl less Hb loss between the preoperative value and the value before discharge reduced total costs by 292 Euros (p < 0.001) and 161 Euros fewer general ward costs (p < 0.001). Total hospital costs were reduced by 144 Euros with 1 g/dl higher Hb on day 2 postoperatively for women (p < 0.01). CONCLUSION Preoperative anemia was associated with increased general ward costs for women and Hb loss with decreasing total hospital costs for men and women. Cost containment, especially reduced utilization of the general ward, may be feasible with the correction of anemia for women. Postoperative Hb values may be a factor for adjustments of reimbursement systems. LEVEL OF EVIDENCE Retrospective cohort study, III.
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Affiliation(s)
- Caroline Schatz
- Ludwig-Maximilians-Universität München, LMU Munich School of Management, Institute for Health Economics and Health Care Management, Ludwigstr. 28, 80539, Munich, Germany.
- Helmholtz Zentrum München, Institute for Health Economics and Health Care Management, Munich, Germany.
- Environmental Health Center at Helmholtz Munich, Munich, Germany.
| | - Werner Plötz
- Krankenhaus Barmherzige Brüder München, Akademisches Lehrkrankenhaus der Technischen Universität München, Munich, Germany
- Klinikum rechts der Isar, Technical University Munich, Munich, Germany
- Orthopaedic Praxis Munich-Nymphenburg, Munich, Germany
| | - Johannes Beckmann
- Krankenhaus Barmherzige Brüder München, Akademisches Lehrkrankenhaus der Technischen Universität München, Munich, Germany
| | - Katharina Bredow
- Helmholtz Zentrum München, Institute for Health Economics and Health Care Management, Munich, Germany
| | - Reiner Leidl
- Ludwig-Maximilians-Universität München, LMU Munich School of Management, Institute for Health Economics and Health Care Management, Ludwigstr. 28, 80539, Munich, Germany
- Helmholtz Zentrum München, Institute for Health Economics and Health Care Management, Munich, Germany
| | - Peter Buschner
- Krankenhaus Barmherzige Brüder München, Akademisches Lehrkrankenhaus der Technischen Universität München, Munich, Germany
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Aljuhani WS, Alanazi AM, Saeed AI, Alhadlaq KH, Alhoshan YS, Aljaafri ZA. Patient-related risk factors of prosthetic joint infections following total hip and knee arthroplasty at King Abdulaziz Medical City, a 10-year retrospective study. J Orthop Surg Res 2023; 18:717. [PMID: 37736732 PMCID: PMC10514936 DOI: 10.1186/s13018-023-04210-9] [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: 09/04/2023] [Accepted: 09/15/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND Total joint arthroplasty (TJA) can be associated with the development of periprosthetic joint infection (PJI). It is necessary to determine the modifiable and non-modifiable risk factors of PJI to provide optimum healthcare to TJA candidates. METHODS This single-center retrospective review investigated 1198 patients who underwent TJA from 2012 to 2022. The data analysis comprised two stages. The first stage was a descriptive analysis, while the second stage was a bivariate analysis. The sociodemographic data, medical history, operative details, and presence of PJI postoperatively were evaluated. RESULTS The study sample consisted of 1198 patients who underwent TJA. The mean patient age was 63 years. Among the patients, only 1.3% had PJI. No comorbidity was significantly related to PJI. General anesthesia was used in almost 21% of the patients and was significantly associated with a higher risk of infection (p = 0.049). An increased operative time was also significantly related to PJI (p = 0.012). Conversely, tranexamic acid (TXA) administration was a protective factor against PJI (p = 0.017). CONCLUSION Although PJI is not a common complication of TJA, multiple risk factors such as general anesthesia and prolonged operative time play a significant role in its development. In contrast, TXA administration is thought to reduce the risk of PJI effectively.
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Affiliation(s)
- Wazzan S Aljuhani
- Department of Orthopedic Surgery, Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Abdullah M Alanazi
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Abdullah I Saeed
- Department of Orthopedic Surgery, Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia
| | - Khalid H Alhadlaq
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Yazeed S Alhoshan
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Ziad A Aljaafri
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
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Ramadanov N, Ostojic M, Lazaru P, Liu K, Hable R, Marinova-Kichikova P, Dimitrov D, Becker R. Risk Factors and Predictors for Functional Outcome and Complication Rate in Total Hip Arthroplasty through Minimally Invasive and Conventional Approaches: A Systematic Review and Meta-Regression Analysis of 41 Randomized Controlled Trials. J Clin Med 2023; 12:5895. [PMID: 37762836 PMCID: PMC10531834 DOI: 10.3390/jcm12185895] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 08/27/2023] [Accepted: 08/29/2023] [Indexed: 09/29/2023] Open
Abstract
OBJECTIVE To investigate and identify risk factors and predictors for the difference in functional outcome and complications between total hip arthroplasty (THA) through minimally invasive and conventional approaches, using a meta-regression analysis of randomized controlled trials (RCTs). METHODS A systematic review of the literature up to 31 July 2022 was performed. A meta-regression was conducted based on a random effects meta-analysis using the Hartung-Knapp-Sidik-Jonkman method. RESULTS A total of 41 RCTs with 3607 patients were found. The following predictors of HHS ≥ 6 months postoperatively were identified: patient age (predictor estimate = 0.14; p < 0.01), avascular necrosis of the femoral head (predictor estimate = -0.03; p = 0.04); incision length (predictor estimate = -0.82; p < 0.01). The following predictors of complication rate were identified: osteoarthritis (predictor estimate = 0.02; p = 0.02); femoral neck fracture (predictor estimate = -0.02; p = 0.02); SuperPATH (predictor estimate = -1.72; p < 0.01). CONCLUSIONS Patient age, avascular necrosis of the femoral head, and incision length were identified as predictors of the effect size of the HHS ≥ 6 months postoperatively; and osteoarthritis, femoral neck fracture, and SuperPATH as predictors of the effect size of the complication rate. Based on these findings, we recommend that more frequent use of minimally invasive THA in elderly patients should be considered. LEVEL OF EVIDENCE I a systematic review of all relevant randomized controlled trials. Registered in PROSPERO on 10 August 2022 (CRD42022350287).
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Affiliation(s)
- Nikolai Ramadanov
- Center of Orthopaedics and Traumatology, Brandenburg Medical School, University Hospital Brandenburg an der Havel, 14770 Brandenburg an der Havel, Germany;
| | - Marko Ostojic
- Department of Orthopedics, University Hospital Mostar, 88000 Mostar, Bosnia and Herzegovina;
| | - Philip Lazaru
- Department of General and Visceral Surgery, Minimally Invasive Surgery and Coloproctology, St. Marien Hospital, 12249 Berlin, Germany;
| | - Kuiliang Liu
- Department for Orthopaedics and Trauma Surgery, Siloah St. Trudpert Hospital, 75179 Pforzheim, Germany;
| | - Robert Hable
- Faculty of Applied Computer Science, Deggendorf Institute of Technology, 94469 Deggendorf, Germany;
| | - Polina Marinova-Kichikova
- Department of Surgical Propaedeutics, Faculty of Medicine, Medical University of Pleven, 5800 Pleven, Bulgaria;
| | - Dobromir Dimitrov
- Department of Surgical Diseases, Faculty of Medicine, Medical University of Pleven, 5800 Pleven, Bulgaria;
| | - Roland Becker
- Center of Orthopaedics and Traumatology, Brandenburg Medical School, University Hospital Brandenburg an der Havel, 14770 Brandenburg an der Havel, Germany;
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Cetik RM, Azboy I, Birinci M, Ozturkmen Y, Kalyenci AS, Atilla B. Predictive value of different glycemic control markers in total hip or knee arthroplasty: A prospective study. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2023; 57:289-293. [PMID: 37823741 PMCID: PMC10724713 DOI: 10.5152/j.aott.2023.23037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 09/11/2023] [Indexed: 10/13/2023]
Abstract
OBJECTIVE The optimal glycemic control marker before total hip or knee arthroplasty remains inconclusive. Hemoglobin A1c (HbA1c) is widely used, while fructosamine may be valuable for predicting periprosthetic joint infection (PJI). Fructosamine levels can be affected by serum albumin levels; albumin-corrected fructosamine (AlbF) can be calculated to overcome this issue. The objective of this study was to evaluate the predictive value of different markers for complications after primary total hip or knee arthroplasty. METHODS This prospective cohort study included 304 patients (mean age: 65 years [range, 16-85), mean follow-up: 32 months (range, 12-49)] who underwent primary total hip or knee arthroplasty between 2018 and 2021. Of them, 156 patients had diabetes. Mean HbA1c was 6.5% (range, 4.8%-13%), fructosamine 244 µmol/L (range, 98-566 µmol/L), and AlbF 632 (range, 238-2308). Patients who did and did not have diabetes were matched 1 : 1. Hemoglobin A1c 7% and fructosamine 292 µmol/L were used as cutoff. Complications were documented. Glycemic markers were compared using logistic regression analyses, with a special focus on PJI. RESULTS In the logistic regression analyses, HbA1c was strongly associated with total complications [adjusted odds ratio (OR): 3.61; 95% CI, 1.65-7.91, P = .001], while fructosamine was associated with PJI (adjusted OR: 13.68; 95% CI, 1.39-134.89, P = .025). Albumin-corrected fructosamine did not show any additional benefits. CONCLUSION Preoperative assessment before total hip or knee arthroplasty must not focus on a single marker; HbA1c is a good predictor of total complications, while fructosamine is a better predictor of PJI. To the best of our knowledge, in its first orthopedic study, AlbF did not show any advantages. LEVEL OF EVIDENCE Level II, Prognostic Study.
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Affiliation(s)
- Riza Mert Cetik
- Department of Orthopedics and Traumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ibrahim Azboy
- Department of Orthopedics and Traumatology, Istanbul Medipol University Faculty of Medicine, Istanbul, Turkey
| | - Murat Birinci
- Department of Orthopedics and Traumatology, Istanbul Medipol University Faculty of Medicine, Istanbul, Turkey
| | - Yusuf Ozturkmen
- Department of Orthopedics and Traumatology, Istanbul Research and Training Hospital, Istanbul, Turkey
| | - Ahmet Sinan Kalyenci
- Department of Orthopedics and Traumatology, Istanbul Research and Training Hospital, Istanbul, Turkey
| | - Bulent Atilla
- Department of Orthopedics and Traumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Blackburn AZ, Katakam A, Roberts T, Humphrey TJ, Salimy MS, Egan CR, Melnic CM, Bedair HS. Visceral Fat as a Risk Factor for Periprosthetic Joint Infection After Total Hip and Knee Arthroplasty. J Arthroplasty 2023; 38:1839-1845.e1. [PMID: 36858130 DOI: 10.1016/j.arth.2023.02.048] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 02/13/2023] [Accepted: 02/15/2023] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND Visceral obesity, a strong indicator of chronic inflammation and impaired metabolic health, has been shown to be associated with poor postoperative outcomes and complications. This study aimed to evaluate the relationship between visceral fat area (VFA) and periprosthetic joint infection (PJI) in total joint arthroplasty (TJA) patients. METHODS A retrospective study of 484 patients who had undergone a total hip or knee arthroplasty was performed. All patients had a computed tomography scan of the abdomen/pelvis within two years of their TJA. Body composition data (ie, VFA, subcutaneous fat area, and skeletal muscle area) were calculated at the Lumbar-3 vertebral level via two fully automated and externally validated machine learning algorithms. A multivariable logistic model was created to determine the relationship between VFA and PJI, while accounting for other PJI risk factors. Of the 484 patients, 31 (6.4%) had a PJI complication. RESULTS The rate of PJI among patients with VFA in the top quartile (> 264.1 cm2) versus bottom quartile (< 82.6 cm2) was 5.6% versus 10.6% and 18.8% versus 2.7% in the total hip arthroplasty and total knee arthroplasty cohorts, respectively. In the multivariate model, total knee arthroplasty patients with a VFA in the top quartile had a 30.5 times greater risk of PJI than those in the bottom quartile of VFA (P = .0154). CONCLUSION VFA may have a strong association with PJI in TJA patients. Using a standardized imaging modality like computed tomography scans to calculate VFA can be a valuable tool for surgeons when assessing risk of PJI.
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Affiliation(s)
- Amy Z Blackburn
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts; Kaplan Joint Center, Newton-Wellesley Hospital, Newton, Massachusetts
| | - Akhil Katakam
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts; Kaplan Joint Center, Newton-Wellesley Hospital, Newton, Massachusetts
| | - Thomas Roberts
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Tyler J Humphrey
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts; Kaplan Joint Center, Newton-Wellesley Hospital, Newton, Massachusetts
| | - Mehdi S Salimy
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Cameron R Egan
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts; Kaplan Joint Center, Newton-Wellesley Hospital, Newton, Massachusetts
| | - Christopher M Melnic
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts; Kaplan Joint Center, Newton-Wellesley Hospital, Newton, Massachusetts
| | - Hany S Bedair
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts; Kaplan Joint Center, Newton-Wellesley Hospital, Newton, Massachusetts
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Challoumas D, Munn D, Stockdale H, Ng N, McCormick M, Altell T, Joiya S, Horton J, Jones B. Outcomes of total hip and knee arthroplasty in special populations: a synopsis and critical appraisal of systematic reviews. ARTHROPLASTY 2023; 5:34. [PMID: 37408050 DOI: 10.1186/s42836-023-00190-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 04/23/2023] [Indexed: 07/07/2023] Open
Abstract
INTRODUCTION This study aimed to present and critically appraise the best available evidence investigating associations between some pre-defined patient-related characteristics and perioperative complications or other outcomes in THA and TKA. METHODS Electronic databases were searched (Medline, EMBASE, Scopus, CENTRAL) for systematic reviews assessing the following pre-defined patient-related characteristics as possible risk factors for worse peri-operative outcomes in THA and TKA: smoking, alcohol excess, rheumatoid arthritis, human immunodeficiency virus infection, hepatitis C virus infection, mental health conditions, and solid organ transplantation. Our primary outcome was periprosthetic joint infection. Results were analysed separately for THA, TKA and THA/TKA (mixed data). RESULTS Based on at least two systematic reviews being in agreement, the following patient-related characteristics were associated with increased incidence of complications as follows: a) Smoking for all-cause revision in THA, for periprosthetic joint infection in TKA and THA/TKA; b) alcohol excess for periprosthetic joint infection in THA/TKA; c) human immunodeficiency virus for periprosthetic joint infection in THA/TKA; d) hepatitis C virus for overall complications, periprosthetic joint infection and all-cause revision in THA and THA/TKA, and for overall complications in TKA. Our study found conflicting evidence for a) smoking as a risk factor for periprosthetic joint infection and aseptic loosening in THA; b) human immunodeficiency virus as a risk factor for all-cause revision for THA/TKA; c) hepatitis C virus as a risk factor for periprosthetic joint infection and all-cause revision in TKA. No certainty of evidence was assigned to these results as this was not assessed by the authors of the majority of the included systematic reviews. CONCLUSION We found that smoking, excess alcohol consumption, RA, and infection with HIV and HCV were associated with a higher incidence of periprosthetic joint infection in one or both of THA and TKA or mixed THA/TKA data. All our results should be interpreted and communicated to patients with caution as the quality of the included systematic reviews was generally poor.
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Affiliation(s)
- Dimitris Challoumas
- Department of Trauma and Orthopaedic Surgery, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 0SF, Scotland, UK.
| | - David Munn
- Department of Trauma and Orthopaedic Surgery, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 0SF, Scotland, UK
| | - Henrietta Stockdale
- Department of Trauma and Orthopaedic Surgery, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 0SF, Scotland, UK
| | - Nigel Ng
- Department of Trauma and Orthopaedic Surgery, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 0SF, Scotland, UK
| | - Michael McCormick
- Department of Trauma and Orthopaedic Surgery, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 0SF, Scotland, UK
| | - Tareq Altell
- Department of Trauma and Orthopaedic Surgery, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 0SF, Scotland, UK
| | - Shaheer Joiya
- Department of Trauma and Orthopaedic Surgery, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 0SF, Scotland, UK
| | - James Horton
- Department of Trauma and Orthopaedic Surgery, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 0SF, Scotland, UK
| | - Bryn Jones
- Department of Trauma and Orthopaedic Surgery, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 0SF, Scotland, UK
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Szymski D, Walter N, Krull P, Melsheimer O, Schindler M, Grimberg A, Alt V, Steinbrueck A, Rupp M. Comparison of mortality rate and septic and aseptic revisions in total hip arthroplasties for osteoarthritis and femoral neck fracture: an analysis of the German Arthroplasty Registry. J Orthop Traumatol 2023; 24:29. [PMID: 37329492 DOI: 10.1186/s10195-023-00711-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 06/02/2023] [Indexed: 06/19/2023] Open
Abstract
BACKGROUND Indications for total hip arthroplasties (THA) differ from primary osteoarthritis (OA), which allows elective surgery through femoral neck fractures (FNF), which require timely surgical care. The aim of this investigation was to compare mortality and revisions in THA for primary OA and FNF. METHODS Data collection for this study was performed using the German Arthroplasty Registry (EPRD) with analysis THA for the treatment of FNF and OA. Cases were matched 1:1 according to age, sex, body mass index (BMI), cementation, and the Elixhauser score using Mahalanobis distance matching. RESULTS Overall 43,436 cases of THA for the treatment of OA and FNF were analyzed in this study. Mortality was significantly increased in FNF, with 12.6% after 1 year and 36.5% after 5 years compared with 3.0% and 18.7% in OA, respectively (p < 0.0001). The proportion for septic and aseptic revisions was significantly increased in FNF (p < 0.0001). Main causes for an aseptic failure were mechanical complications (OA: 1.1%; FNF: 2.4%; p < 0.0001) and periprosthetic fractures (OA: 0.2%; FNF: 0.4%; p = 0.021). As influencing factors for male patients with septic failure (p < 0.002), increased BMI and Elixhauser comorbidity score and diagnosis of fracture (all p < 0.0001) were identified. For aseptic revision surgeries, BMI, Elixhauser score, and FNF were influencing factors (p < 0.0001), while all cemented and hybrid cemented THA were associated with a risk reduction for aseptic failure within 90 days after surgery (p < 0.0001). CONCLUSION In femoral neck fractures treated with THA, a significant higher mortality, as well as septic and aseptic failure rate, was demonstrated compared with prosthesis for the therapy of osteoarthritis. Increased Elixhauser comorbidity score and BMI are the main influencing factors for development of septic or aseptic failure and can represent a potential approach for prevention measures. LEVEL OF EVIDENCE Level III, Prognostic.
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Affiliation(s)
- Dominik Szymski
- Department for Trauma Surgery, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Nike Walter
- Department for Trauma Surgery, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Paula Krull
- Endoprothesenregister Deutschland gGmbH (EPRD), Berlin, Germany
| | | | - Melanie Schindler
- Department for Trauma Surgery, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | | | - Volker Alt
- Department for Trauma Surgery, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Arnd Steinbrueck
- Endoprothesenregister Deutschland gGmbH (EPRD), Berlin, Germany
- Orthopädisch Chirurgisches Kompetenzzentrum Augsburg (OCKA), Augsburg, Germany
| | - Markus Rupp
- Department for Trauma Surgery, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany.
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Cheng AL, Carbonell KV, Prather H, Hong BA, Downs DL, Metzler JP, Hunt DM. Unique characteristics of patients who choose an intensive lifestyle medicine program to address chronic musculoskeletal pain. PM R 2023; 15:761-771. [PMID: 35567523 PMCID: PMC9659670 DOI: 10.1002/pmrj.12847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 04/20/2022] [Accepted: 05/01/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Factors that motivate musculoskeletal patients to pursue an intensive, lifestyle medicine-based approach to care are poorly understood. OBJECTIVE To determine whether, compared to patients seeking musculoskeletal care through traditional pathways, patients who choose an intensive lifestyle medicine program for musculoskeletal pain endorse greater physical dysfunction, worse psychological health, and/or more biopsychosocial comorbidities. DESIGN Cross-sectional analysis of existing medical records from 2018 to 2021. SETTING Orthopedic department of one academic medical center. PATIENTS Fifty consecutive patients who enrolled in an intensive lifestyle medicine program to address a musculoskeletal condition. Comparison groups were the following: (1) 100 patients who presented for standard nonoperative musculoskeletal care, and (2) 100 patients who presented for operative evaluation by an orthopedic surgeon and qualified for joint arthroplasty. INTERVENTION Not applicable. MAIN OUTCOME MEASURES Primary outcomes were age-adjusted, between-group differences in Patient-Reported Outcomes Measurement Information System (PROMIS) physical and psychological health measures. Secondary outcomes were between-group differences in sociodemographic and medical history characteristics. RESULTS Patients who enrolled in the intensive lifestyle medicine program were more racially diverse (non-White race: lifestyle cohort 34% vs. comparison cohorts 16%-18%, p ≤ .029) and had a higher prevalence of obesity and diabetes than both comparison groups (mean body mass index: lifestyle cohort 37.6 kg/m2 vs. comparison cohorts 29.3-32.0, p < .001; diabetes prevalence: lifestyle cohort 32% vs. comparison cohorts 12%-16%, p ≤ .024). Compared to standard nonoperative patients, there were no clear between-group differences in PROMIS physical or psychological health scores. Compared to standard operative evaluation patients, patients in the lifestyle program reported worse anxiety but less pain interference (PROMIS Anxiety: B = 3.8 points [95% confidence interval, 0.1 to 7.4], p = .041; Pain interference: B = -3.6 [-6.0 to -1.2], p = .004). CONCLUSIONS Compared to musculoskeletal patients who sought care through traditional pathways, patients who chose an intensive lifestyle medicine pathway had a higher prevalence of metabolic comorbidities, but there was substantial overlap in patients' physical, psychological, and sociodemographic characteristics.
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Affiliation(s)
- Abby L Cheng
- Division of Physical Medicine and Rehabilitation, Department of Orthopaedic Surgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | | | - Heidi Prather
- Department of Physiatry, Hospital for Special Surgery, Weill Cornell Medical College, New York City, New York, USA
| | - Barry A Hong
- Department of Psychiatry, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Dana L Downs
- Department of Psychiatry, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - John P Metzler
- Division of Physical Medicine and Rehabilitation, Department of Orthopaedic Surgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Devyani M Hunt
- Division of Physical Medicine and Rehabilitation, Department of Orthopaedic Surgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
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Supra R, Supra R, Agrawal DK. Surgical Approaches in Total Hip Arthroplasty. JOURNAL OF ORTHOPAEDICS AND SPORTS MEDICINE 2023; 5:232-240. [PMID: 37388321 PMCID: PMC10310317 DOI: 10.26502/josm.511500106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
The Total Hip Arthroplasty (THA) has become one of the most reliable surgical interventions that has improved the quality of life in many patients. THA allows patients to have increased mobility, range of motion, and reduced pain in patients with degenerative hip joints. This surgical procedure has become an effective treatment option for several chronic conditions affecting the hip joint. Although this surgery has been shown to give promising results in patients with hip pathology, selecting the approach for THA is a critical step in pre-operative planning. The best approach for this surgical procedure depends on multiple factors and each present with their own challenges, success rates, and limitations. To further elucidate the advantages and disadvantages associated with different surgical approaches, we critically review each surgical approach along with the different causes of failure of the THA procedure.
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Affiliation(s)
- Rajiv Supra
- College of Osteopathic Medicine, Touro University, Henderson, Nevada, USA
| | - Rajesh Supra
- Georgetown University School of Medicine, Washington, DC, USA
| | - Devendra K Agrawal
- Department of Translational Research, College of Osteopathic Medicine of the Pacific, Pomona, California, USA
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Yang Z, Ji W, Xia Y, Wang X. Late summer is a risk factor for periprosthetic joint infection after total joint arthroplasty: A retrospective cohort study. Medicine (Baltimore) 2023; 102:e33089. [PMID: 36897712 PMCID: PMC9997820 DOI: 10.1097/md.0000000000033089] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 02/03/2023] [Indexed: 03/11/2023] Open
Abstract
To explore whether season is a risk factor of periprosthetic joint infection (PJI) after total joint arthroplasty (TJA) and explain it with the theory of traditional Chinese medicine. This was a retrospective cohort study. Only patients who suffered from PJI within 1 month after TJA were included in the study. Occurrence of PJI was the outcome of this study. Chi-squared test and t test was used to assess differences for baseline characteristics. Chi-square test was used to analyze whether season was related to the occurrence of PJI. Logistic regression was used to evaluate the association between season and occurrence of PJI. The incidence of PJI in summer is significantly higher than that in winter, whether after total knee arthroplasty (Chi-square value = 6.455, P = .011) or total hip arthroplasty (Chi-square value = 6.141, P = .013). Summer was an independent risk factor for PJI (OR = 4.373, 95% confidence interval = 1.899-10.673, P = .004). To be more exact, compared to nonlate summer (19.51%), and PJI is mainly concentrated in late summer (80.49%). Late summer was an independent risk factor of PJI after TJA. The infection rate of PJI after TJA in late summer is higher than other seasons. A more thorough preoperative disinfection procedure is needed in late summer.
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Affiliation(s)
- Ze Yang
- The First Clinical College of Zhejiang Traditional Chinese Medical University, Hangzhou, China
| | - Weifeng Ji
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, China
| | - Yongliang Xia
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, China
| | - Xiang Wang
- Department of Orthopedics, Tongde Hospital of Zhejiang Province, Hangzhou, China
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Trends in Revision Hip Arthroplasty for Prosthetic Joint Infection: A Single-Center Study of 423 Hips at a High-Volume Center Between 2008 and 2021. J Arthroplasty 2023; 38:1151-1159. [PMID: 36863575 DOI: 10.1016/j.arth.2023.02.061] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 02/16/2023] [Accepted: 02/21/2023] [Indexed: 03/04/2023] Open
Abstract
BACKGROUND Prosthetic joint infection (PJI) is one of the most devastating complications after total hip arthroplasty (THA), and comorbidities increase the risk. We examined whether there was a temporal change in the demographics, especially regarding comorbidities, of patients who have PJIs and were treated over a 13-year study period at a high-volume academic joint arthroplasty center. In addition, the surgical methods used and the microbiology of the PJIs were assessed. METHODS Revisions (n = 423, 418 patients) due to PJI of the hip performed at our institution between 2008 and September 2021 were identified. All included PJIs fulfilled the 2013 International Consensus Meeting diagnostic criteria. The surgeries were categorized into one of the following categories: debridement, antibiotics, and implant retention, 1-stage revision, and 2-stage revision. Infections were classified as early, acute hematogenous, and chronic infections. RESULTS There was no change in the median age of the patients, but the proportion of ASA-class 4 patients increased from 10.5% to 20%. The incidence of early infections increased from 0.11 per 100 primary THAs in 2008 to 1.09 in 2021. The incidence of 1-stage revisions increased the most, rising from 0.10 per 100 primary THAs in 2010 to 0.91 per 100 primary THAs in 2021. Furthermore, the proportion of infections caused by Staphylococcus aureus increased from 26.3% in 2008 to 2009 to 40% in 2020 to 2021. CONCLUSION The comorbidity burden of PJI patients increased during the study period. This increase may present a treatment challenge, as comorbidities are known to have a negative effect on PJI treatment outcomes.
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Spichler-Moffarah A, Rubin LE, Bernstein JA, O'Bryan J, McDonald E, Golden M. Prosthetic Joint Infections of the Hip and Knee Among the Elderly: A Retrospective Study. Am J Med 2023; 136:100-107. [PMID: 36063860 DOI: 10.1016/j.amjmed.2022.08.006] [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: 07/14/2022] [Revised: 08/15/2022] [Accepted: 08/16/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND As the population ages and demand for total joint arthroplasty increases, rates of periprosthetic joint infection are expected to increase in the geriatric population. Studies comparing prevalence of risk factors, etiology, management, and mortality of prosthetic joint infection in older patients are lacking. METHODS We compared clinical characteristics, management, and mortality of patients <75 vs ≥75 years of age with first prosthetic joint infection of the hip or knee admitted to a tertiary medical center between September 2017 and December 2019. RESULTS Ninety-eight patients (<75 years of age [n = 63]; ≥75 years of age (n = 35) were studied. Groups were similar in terms of etiology, culture-directed therapy, antibiotic suppression, and length of stay. There was no difference in surgical management, performed in almost 97% of cases in both groups. Arrhythmia and heart failure were more prevalent in those aged ≥75 years. Readmission related to prosthetic joint infection occurred less often in older individuals (P = .005). Deaths within 1 year of diagnosis were rare (n = 4; 4.1%), occurring in older patients and resulting mostly from sepsis. CONCLUSION In our single-center study, patients with first prosthetic joint infection had similar management, regardless of age. We identified cardiac history as one of the host factors for prosthetic joint infection most seen in patients ≥75 years of age. Although deaths were rare, 1-year mortality was higher in patients aged ≥75. Prospective, multicenter studies are needed to explore risk factors and management strategies of prosthetic joint infection among elderly populations.
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Affiliation(s)
- Anne Spichler-Moffarah
- Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, Conn.
| | - Lee E Rubin
- Division of Adult Reconstruction, Department of Orthopedics & Rehabilitation, Yale University School of Medicine, Yale New Haven Health, New Haven, Conn
| | - Jenna A Bernstein
- Division of Adult Reconstruction, Department of Orthopedics & Rehabilitation, Yale University School of Medicine, Yale New Haven Health, New Haven, Conn
| | - Jane O'Bryan
- Department of Obstetrics, Gynecology & Reproductive Sciences, Yale School of Medicine, New Haven, Conn; Frank H. Netter MD School of Medicine at Quinnipiac University, North Haven, Conn
| | - Erik McDonald
- Division of Adult Reconstruction, Department of Orthopedics & Rehabilitation, Yale University School of Medicine, Yale New Haven Health, New Haven, Conn
| | - Marjorie Golden
- Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, Conn
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Vinther D, Mailhac A, Andersen IT, Overgaard S, Lie SA, Fenstad AM, Gjertsen JE, Furnes O, Pedersen AB. Association between duration of anticoagulant thromboprophylaxis and revision rate in primary total hip arthroplasty: a Danish and Norwegian nationwide cohort study. Acta Orthop 2022; 93. [PMID: 36576374 PMCID: PMC9795858 DOI: 10.2340/17453674.2022.6243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 12/08/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND AND PURPOSE There are concerns that bleeding following primary total hip arthroplasty (THA) contributes to prolonged wound drainage and prosthetic joint infection (PJI). We examined whether short (1-5 days), medium (6-14 days), and extended (≥ 15 days) duration of thromboprophylaxis is associated with the 5-year revision rate after THA due to osteoarthritis. PATIENTS AND METHODS We performed a cohort study based on data from hip arthroplasty and administrative registries in Denmark and Norway (2008-2014). The outcome was revision surgery due to PJI, aseptic loosening or any cause, and patient mortality. Adjusted cause-specific hazard ratios (HRs) were analyzed with Cox regression analyses. RESULTS Among 50,482 THA patients, 8,333 received short, 17,009 received medium, and 25,140 received extended thromboprophylaxis. The HRs for revision due to PJI within 5 years were 1.0 (95%CI 0.7-1.3) and 1.1 (CI 0.9-1.3) for short and extended vs. medium treatment, whereas HR for extended vs. medium prophylaxis was 1.5 (CI 1.2-2.0) within 3 months. The HRs for revision due to aseptic loosening within 5 years were 1.0 (CI 0.7-1.4) and 1.1 (CI 0.9-1.4) for short and extended vs. medium treatment. The HRs for any revision within 5 years were 0.9 (CI 0.8-1.1) and 0.9 (CI 0.8-1.0) for short and extended vs. medium treatment. Extended vs. medium prophylaxis was associated with a decreased 0-3 month mortality. The absolute differences at 5 years were ≤ 1%. CONCLUSION Our data suggests no association between duration of anticoagulant thromboprophylaxis and revision rate within 5 years of primary THA. The extended thromboprophylaxis might be associated with early increased revision rate due to PJI but also with lower mortality; however, the clinical relevance of this finding requires further research.
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Affiliation(s)
- Dennis Vinther
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus; Department of Clinical Medicine, Aarhus University, Aarhus.
| | - Aurelie Mailhac
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus
| | | | - Søren Overgaard
- Department of Orthopaedic Surgery and Traumatology, Copenhagen University Hospital, Bispebjerg, and The Danish Hip Arthroplasty Register; Department of Clinical Medicine, Faculty of Health and Medical Sciences Register, Copenhagen, Denmark
| | - Stein Atle Lie
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen; Department of Clinical Dentistry, University of Bergen, Bergen
| | - Anne Marie Fenstad
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen
| | - Jan-Erik Gjertsen
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen; Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Ove Furnes
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen; Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Alma B Pedersen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus; Department of Clinical Medicine, Aarhus University, Aarhus
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Balato M, Petrarca C, Arpaia P, Moccaldi N, Mancino F, Carleo G, Minucci S, Mariconda M, Balato G. Detecting and Monitoring Periprosthetic Joint Infection by Using Electrical Bioimpedance Spectroscopy: A Preliminary Case Study. Diagnostics (Basel) 2022; 12:diagnostics12071680. [PMID: 35885583 PMCID: PMC9323083 DOI: 10.3390/diagnostics12071680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 06/30/2022] [Accepted: 07/08/2022] [Indexed: 12/03/2022] Open
Abstract
A method to detect the presence of infection after Total Joint Arthroplasty is presented. The method is based on Electrical Bioimpedance Spectroscopy and guarantees low latency, non-invasiveness, and cheapness with respect to the state of art. Experimental measurements were carried out on a singular patient who had already undergone bilateral Total Knee Arthroplasty. He was affected by a hematogenous Periprosthetic Joint Infections on the left knee. The right knee was adopted as the reference. Measurements were acquired once before the surgical procedure (Diagnosis Phase) and twice in the postoperative phases (Monitoring Phase). The most relevant frequency range, for diagnosis and monitoring phases, was found to be between 10 kHz to 50 kHz. The healing trend predicted by the decrease of impedance magnitude spectrum was reflected in clinical and laboratory results. In addition, one month after the last acquisition (two months after the surgery), the patient fully recovered, confirming the prediction of the Electrical Bioimpedance Spectroscopy technique.
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Affiliation(s)
- Marco Balato
- Department of Electrical Engineering and Information Technologies (DIETI), University of Naples “Federico II”, 80125 Napoli, Italy; (C.P.); (P.A.); (N.M.); (F.M.)
- Correspondence:
| | - Carlo Petrarca
- Department of Electrical Engineering and Information Technologies (DIETI), University of Naples “Federico II”, 80125 Napoli, Italy; (C.P.); (P.A.); (N.M.); (F.M.)
| | - Pasquale Arpaia
- Department of Electrical Engineering and Information Technologies (DIETI), University of Naples “Federico II”, 80125 Napoli, Italy; (C.P.); (P.A.); (N.M.); (F.M.)
- Interdepartmental Research Center on Management and Innovation in Healthcare, (CIRMIS), University of Naples “Federico II”, 80131 Napoli, Italy;
| | - Nicola Moccaldi
- Department of Electrical Engineering and Information Technologies (DIETI), University of Naples “Federico II”, 80125 Napoli, Italy; (C.P.); (P.A.); (N.M.); (F.M.)
| | - Francesca Mancino
- Department of Electrical Engineering and Information Technologies (DIETI), University of Naples “Federico II”, 80125 Napoli, Italy; (C.P.); (P.A.); (N.M.); (F.M.)
| | - Giusy Carleo
- Department of Neuroscience and Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, 80131 Napoli, Italy;
| | - Simone Minucci
- Department of Economics, Engineering, Society and Business Organization (DEIM), University of Tuscia, 01100 Viterbo, Italy;
| | - Massimo Mariconda
- Interdepartmental Research Center on Management and Innovation in Healthcare, (CIRMIS), University of Naples “Federico II”, 80131 Napoli, Italy;
- Department of Public Health, University of Naples “Federico II”, 80131 Napoli, Italy;
| | - Giovanni Balato
- Department of Public Health, University of Naples “Federico II”, 80131 Napoli, Italy;
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The Role of Dexmedetomidine in the Structure of Anesthesia for Hip and Knee Arthroplastyс Surgery in Patients with Diabetes. Fam Med 2022. [DOI: 10.30841/2307-5112.1-2.2022.260504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Hip and knee arthroplasty (HKA) is a surgical procedure when damaged parts of the joint are replaced with artificial ones that replicate the shape of a normal joint and restore its function.
Every year more than 1.5 million endoprosthetic operations are performed in the world. Replacement of a damaged joint allows patients to return to the normal life, freeing from pain and limited mobility. However, one of the common diseases that negatively affect the results of these operations is diabetes mellitus (DM).
The aim of the study: to determine the efficacy and safety of the combined multimodal low opioid anesthesia with dexmedetomidine sedation in patients with diabetes undergoing HKA surgery.
Materials and methods. The study included 45 patients who underwent HKA surgery. Patients were divided into three groups according to the scheme of anesthesia. In patients of the 1st group (n = 15) multicomponent low-flow anesthesia with artificial lung ventilation was performed, in the patients of the 2nd group (n = 15) spinal anesthesia was used, in the 3rd group (n = 15) – combined spinal – epidural anesthesia with dexmedetomidine sedation.
The groups of patients were identical in anthropometric and gender characteristics, duration of surgery and anesthesia, baseline somatic status.
Statistical analysis was performed using the IBM SPSS Statistics suite (SPSS v.16.0).
Results. The course of anesthesia in patients in all groups was satisfactory, but patients in group 3 were less likely to experience hyperdynamic reactions (tachycardia and hypotension), postoperative nausea and vomiting (PONV). Only one patient from group 3 required ondansetron for the treatment of PONV against 3 and 2 patients from groups 1 and 2, respectively (p <0.05).
Conclusions. Any of the proposed techniques can be used for anesthesia during hip and knee arthroplasty, but the best results have been obtained with combined spinal-epidural anesthesia with dexmedetomidine sedation. In addition, the use of dexmedetomidine can significantly reduce the use of opioids diring the intraoperative and postoperative period.
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43
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Atkin B, Dupley L, Chakravorty P, Zafar K, Boden R. Approach to patients with a potential prosthetic joint infection. BMJ 2022; 376:e069502. [PMID: 35314426 DOI: 10.1136/bmj-2021-069502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- B Atkin
- University Hospitals Birmingham NHS Foundation Trust, UK
| | - L Dupley
- Lancashire Teaching Hospitals NHS Foundation Trust, UK
| | - P Chakravorty
- Lancashire Teaching Hospitals NHS Foundation Trust, UK
| | - K Zafar
- New Collegiate Medical Centre, Cheetham Hill and Crumpsall Primary Care Network, Manchester, UK
| | - R Boden
- Lancashire Teaching Hospitals NHS Foundation Trust, UK
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Bülow E, Hahn U, Andersen IT, Rolfson O, Pedersen AB, Hailer NP. Prediction of Early Periprosthetic Joint Infection After Total Hip Arthroplasty. Clin Epidemiol 2022; 14:239-253. [PMID: 35281208 PMCID: PMC8904265 DOI: 10.2147/clep.s347968] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 02/18/2022] [Indexed: 11/30/2022] Open
Abstract
Purpose To develop a parsimonious risk prediction model for periprosthetic joint infection (PJI) within 90 days after total hip arthroplasty (THA). Patients and Methods We used logistic LASSO regression with bootstrap ranking to develop a risk prediction model for PJI within 90 days based on a Swedish cohort of 88,830 patients with elective THA 2008–2015. The model was externally validated on a Danish cohort with 18,854 patients. Results Incidence of PJI was 2.45% in Sweden and 2.17% in Denmark. A model with the underlying diagnosis for THA, body mass index (BMI), American Society for Anesthesiologists (ASA) class, sex, age, and the presence of five defined comorbidities had an area under the curve (AUC) of 0.68 (95% CI: 0.66 to 0.69) in Sweden and 0.66 (95% CI: 0.64 to 0.69) in Denmark. This was superior to traditional models based on ASA class, Charlson, Elixhauser, or the Rx Risk V comorbidity indices. Internal calibration was good for predicted probabilities up to 10%. Conclusion A new PJI prediction model based on easily accessible data available before THA was developed and externally validated. The model had superior discriminatory ability compared to ASA class alone or more complex comorbidity indices and had good calibration. We provide a web-based calculator (https://erikbulow.shinyapps.io/thamortpred/) to facilitate shared decision making by patients and surgeons. ![]()
Point your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use: https://youtu.be/T0qfHTvBEs4
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Affiliation(s)
- Erik Bülow
- The Swedish Arthroplasty Register, Centre of Registers Västra Götaland, Gothenburg, Sweden
- Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Correspondence: Erik Bülow, The Swedish Arthroplasty Register, Centre of Registers Västra Götaland, Gothenburg, SE-413 45, Sweden, Tel +46 70 08 234 28, Email
| | - Ute Hahn
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Mathematics, Aarhus University, Aarhus, Denmark
| | - Ina Trolle Andersen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Ola Rolfson
- The Swedish Arthroplasty Register, Centre of Registers Västra Götaland, Gothenburg, Sweden
- Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Alma B Pedersen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Nils P Hailer
- Department of Surgical Sciences/Orthopaedics, Uppsala University Hospital, Uppsala, Sweden
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