Comparisons of in-hospital complications between total hip arthroplasty and hip resurfacing arthroplasty

Hip Resurfacing Arthroplasty in Men: A Minimum 15-Year Follow-Up Study

BACKGROUND

Hip resurfacing arthroplasty (HRA) has emerged as an alternative to total hip arthroplasty (THA) for managing osteoarthritis, particularly in younger, active men. However, long-term data on HRA outcomes in the United States remains limited.

METHODS

We retrospectively examined 472 consecutive HRA cases in 407 men performed between January 2006 and December 2008 with a minimum 15-year follow-up outcomes. Patient-reported outcome measures (PROMs), including the modified Harris Hip Score (mHHS), Hip Disability and Osteoarthritis Outcome Score for Joint Replacement (HOOS-JR), Visual Analog Scale (VAS) for pain, and University of California-Los Angeles (UCLA) Activity Scale, were collected. Serum metal ion levels, survivorship, and radiographic outcomes were also assessed. Kaplan-Meier survival analysis was performed to evaluate implant survivorship. The mean follow-up was 16.0 years (range, 15.0 to 18.4).

RESULTS

The overall survivorship at 15 years was 95.1%. Implants with femoral head sizes ≥ 48 mm demonstrated 95.8% survivorship, while those < 48 mm showed 91.3% survivorship. For unrevised hips, mean final follow-up scores were HOOS-JR 97.8 ± 5.6, mHHS 97.3 ± 6.4, VAS 0.4 ± 1.1, and UCLA Activity 8.0 ± 1.9. The median serum metal ion levels at the final follow-up were 2.3 μg/L for chromium and 1.7 μg/L for cobalt. There were 26 revisions that occurred, with aseptic loosening being the most common cause (n = 11).

CONCLUSION

This study demonstrates that HRA is a viable long-term solution for appropriately selected men with high survivorship and positive functional outcomes at a minimum 15-year follow-up.

Analysis of Postoperative Complication and Revision Rates and Mid- to Long-Term Implant Survival in Primary Short-Stem Total Hip Arthroplasty

Background/Objectives: Short-stem prostheses were introduced as an alternative to conventional straight-stem prostheses. Despite their benefits, including minimally invasive approaches, soft-tissue- and bone-sparing implantation, and physiological load transfer to the metaphysis, data on postoperative complication and revision rates as well as on implant survival are scarce. Methods: A retrospective analysis of 1327 patients who underwent primary total hip arthroplasty (THA) using the Metha® short stem between 2006 and 2023 was conducted. Complication and revision rates were analysed for the intraoperative, direct postoperative, and follow-up episodes. Implant survival was analysed with the endpoint of all-cause stem revision. Results: Intraoperative complications were observed in 3.77% of the cases and included 44 hairline cracks and 6 fractures. In 15 cases (30.0%), conversion to a straight-stem or revision implant was necessary. The direct postoperative complication rate was 2.44%, and 11 revision procedures were performed during inpatient stay (0.84%). Mean follow-up was 7 years (range 1-17). During follow-up, femoral component revision was performed in 60 cases. Aseptic loosening and stem subsidence accounted for a combined percentage of 80% of all indications. Implant survival rate was 95.66% after 5 years, 95.58% after 10 years, and 95.50% after 15 years. Conclusions: Our study provides a comprehensive analysis of postoperative complication and revision rates in a large sample undergoing primary short-stem THA. Postoperative complication rates were favourable, and the long-term implant survival rates were comparable to conventional straight-stem prostheses. Therefore, short-stem THA may be considered an alternative for younger patients.

Risk factors for urinary tract infection in geriatric hip fracture patients: a systematic review and meta-analysis

Background

Urinary tract infection (UTI) is a prevalent and consequential complication in hip fracture patients, leading to significant disability and heightened healthcare expenditures. Consequently, there is a critical need for a comprehensive systematic review to identify risk factors and establish early and effective preventive measures.

Methods

A comprehensive search was performed across the PubMed, Cochrane, Embase, Web of Science, and Scopus databases (up to August 31, 2023). Article screening, data extraction, and quality assessment were independently completed by two reviewers.

Results

Forty-four studies were eligible for inclusion, yielding an overall incidence rate of 11% (95% CI: 8%-14%). Our pooled analysis revealed 18 significant risk factors, including being female (OR = 2.23, 95% CI: 1.89-2.63), advanced age (MD = 1.35, 95% CI: 0.04-2.66), obesity (OR = 1.21, 95% CI: 1.11-1.31), catheterization (OR = 3.8, 95% CI: 2.29-6.32), blood transfusion (OR = 1.39, 95% CI: 1.21-1.58), American Society of Anesthesiologists ≥III (OR = 1.28, 95% CI: 1.18-1.40), general anesthesia (OR = 1.26, 95% CI: 1.11-1.43), intertrochanteric fracture (OR = 1.25, 95% CI: 1.01-1.54), hemiarthroplasty (OR = 1.43, 95% CI: 1.19-1.69), prolonged length of hospital stay (MD = 1.44, 95% CI: 0.66-2.23), delirium (OR = 2.66, 95% CI: 2.05-3.47), dementia (OR = 1.82, 95% CI: 1.62-2.06), Parkinson's disease (OR = 1.53, 95% CI: 1.46-1.61), diabetes (OR = 1.27, 95% CI: 1.13-1.43), hypertension (OR = 1.14, 95% CI: 1.03-1.26), congestive heart failure (OR = 1.35, 95% CI: 1.10-1.66), history of sepsis (OR = 7.13, 95% CI: 5.51-9.22), and chronic steroid use (OR = 1.29, 95% CI: 1.06-1.57).

Conclusion

Our study identifies numerous risk factors strongly associated with UTI, offering compelling evidence and actionable strategies for improving clinical prediction, enabling early intervention, and facilitating targeted UTI management.

Systematic review registration

identifier [CRD42023459600], https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=459600.