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Acuña AJ, Forlenza EM, Serino J, Terhune EB, Della Valle CJ. Body Mass Index Does Not Drive the Risk for Early Postoperative Instability After Total Hip Arthroplasty: A Matched Cohort Analysis. J Arthroplasty 2024:S0883-5403(24)00239-0. [PMID: 38499164 DOI: 10.1016/j.arth.2024.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 03/07/2024] [Accepted: 03/09/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND Instability remains the leading cause of revision following total hip arthroplasty (THA). The objective of the present investigation was to determine whether an elevated body mass index (BMI) is associated with an increased risk of instability after primary THA. METHODS An administrative claims database was queried for patients undergoing elective, primary THA for osteoarthritis between 2010 and 2022. Patients who underwent THA for a femoral neck fracture were excluded. Patients who had an elevated BMI were grouped into the following cohorts: 25 to 29.9 (n = 2,313), 30 to 34.9 (n = 2,230), 35 to 39.9 (n = 1,852), 40 to 44.9 (n = 1,450), 45 to 49.9 (n = 752), and 50 to 59.9 (n = 334). Patients were matched 1:1 based on age, sex, and Elixhauser Comorbidity Index, as well as a history of spinal fusion, neurodegenerative disorders, and alcohol abuse, to controls with a normal BMI (20 to 24.9). A multivariate logistic regression controlling for age, sex, Elixhauser Comorbidity Index, and additional risk factors for dislocation was used to evaluate dislocation rates at 30 days, 90 days, 6 months, 1 year, and 2 years. Rates of revision for instability were similarly compared at 1 year and 2 years postoperatively. RESULTS No significant differences in dislocation rate were observed between control patients and each of the evaluated BMI classes at all evaluated postoperative intervals (all P values > .05). Similarly, the risk of revision for instability was comparable between the normal weight cohort and each evaluated BMI class at 1 year and 2 years postoperatively (all P values > .05). CONCLUSIONS Controlling for comorbidities and known risk factors for instability, the present analysis demonstrated no difference in rates of dislocation or revision for instability between normal-weight patients and those in higher BMI classes.
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Affiliation(s)
- Alexander J Acuña
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Enrico M Forlenza
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Joseph Serino
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - E Bailey Terhune
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Craig J Della Valle
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois
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Bloemheuvel EM, van Steenbergen LN, Swierstra BA, Schreurs BW. Revision Risk of Unipolar and Bipolar Hemiarthroplasties in the Dutch Arthroplasty Register. J Arthroplasty 2024; 39:118-123. [PMID: 37454950 DOI: 10.1016/j.arth.2023.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 07/03/2023] [Accepted: 07/10/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND Hemiarthroplasty (HA) for hip fractures can be performed with a unipolar or bipolar head. We describe the use of unipolar and bipolar HA after a hip fracture in the Netherlands and determined revision rates and risk factors. METHODS All HAs for an acute hip fracture registered in the Dutch Arthroplasty Register (LROI) during 2007 to 2021 were included; 44,127(88%) unipolar and 6,013(12%) bipolar HAs. Competing risk survival analyses were performed with revision for any reason as the endpoint. Multivariable Cox regression analyses were performed adjusting for patient and surgery-related factors. RESULTS The 1-year, 5-year, and 10-year revision rates were comparable for unipolar and bipolar HA. Cox regression analysis showed a hazard ratio of 1.2 (95% confidence interval (CI) 1.0 to 1.4)) after adjustment for confounders for bipolar heads. In cases of a cemented stem, the 1-year cumulative incidence of revision was lower (1.5% (CI 1.4 to 1.7%) compared to uncemented stems (2.4% (CI 2.1 to 2.7%); uncemented stems showed higher risks for revision after adjustment compared to cemented stems (hazard ratio 1.4 (CI 1.2 to 1.5)). The anterior, antero-lateral, and straight-lateral approach showed lower risk for revision compared to the postero-lateral approach. CONCLUSION The revision rate for bipolar HA and unipolar HA was comparable. However, after adjustment for potential confounders the risk for revision showed an estimated 20% increased revision risk for bipolar heads, although not statistically significant. For both head types, the risk for revision was significantly higher when an uncemented stem was chosen or the postero-lateral approach was used.
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Affiliation(s)
- Esther M Bloemheuvel
- Department of Orthopaedics, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | | | - Bart A Swierstra
- Dutch Arthroplasty Register (LROI), 's Hertogenbosch, The Netherlands
| | - Berend W Schreurs
- Department of Orthopaedics, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands; Dutch Arthroplasty Register (LROI), 's Hertogenbosch, The Netherlands
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Paek S, Zelenty WD, Dodo Y, Sarin M, Shue J, Soffin EM, Cammisa FP, Girardi FP, Sama AA, Lyman S, Hughes AP. Up to 10-year surveillance comparison of survivability in single-level cervical disc replacement versus anterior cervical discectomy and fusion in New York. J Neurosurg Spine 2023:1-10. [PMID: 37086159 DOI: 10.3171/2023.3.spine221377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 03/15/2023] [Indexed: 04/23/2023]
Abstract
OBJECTIVE Cervical disc replacement (CDR) is an alternative treatment to anterior cervical discectomy and fusion (ACDF), which is the current gold standard, for degenerative cervical diseases such as cervical spondylotic myelopathy and cervical radiculopathy. CDR has several theoretical benefits over ACDF, including preservation of motion, earlier return to unrestricted activity, and potentially a lower risk of adjacent-segment disease. Recent literature has reported positive clinical results for CDR, but few studies have investigated the long-term risk of revision surgery of CDR versus ACDF. The purpose of this study was to identify and analyze the epidemiological, clinical, and operative risk factors that affect revision rates following single-level CDR and ACDF procedures. METHODS A retrospective cohort was extracted from the Statewide Planning and Research Cooperative System using ICD-9 and CPT codes. Inclusion criteria were adult patients undergoing primary, subaxial (C3-7), single-level ACDF or CDR for cervical radiculopathy and/or cervical spondylotic myelopathy between 2005 and 2013. Survivability was defined as the time between the index procedure and the presence of a subsequent discharge record for cervical spinal fusion or disc replacement. Statistical analyses were performed using chi-square tests, t-tests, Cox proportional hazards models, and a Kaplan-Meier plot. RESULTS A total of 7450 patients were included in this study (6615 ACDF and 835 CDR). When adjusted for patient demographics, the hazard ratios showed no significant differences in the incidence of revision risk between the two cohorts. The CDR cohort had a higher incidence of postoperative dysphagia (p < 0.05). Patients undergoing ACDF had a longer average hospital stay (2.8 vs 1.9 days, p < 0.001). There was no significant difference in time to revision surgery (p = 0.486). CONCLUSIONS CDR and ACDF have both been shown to be effective treatments for cervical spine disease. CDR patients had a shorter average inpatient hospital stay compared with ACDF patients but tended to experience dysphagia more frequently. There was a tendency toward increased survivability of CDR; however, this was not found to be statistically significant at any time point. The large size and heterogeneity of each cohort and the availability of > 10 years of surveillance data differentiate this study from other published literature. This investigation has limitations inherent to large data analysis studies, including the implementation and inaccuracy of diagnosis and procedural coding; however, this reflects real-world use of coding by practitioners.
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Affiliation(s)
- Samuel Paek
- 1Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania
| | - William D Zelenty
- 2Department of Orthopaedic Surgery, Spine Care Institute, Hospital for Special Surgery, New York, New York; and
| | - Yusuke Dodo
- 2Department of Orthopaedic Surgery, Spine Care Institute, Hospital for Special Surgery, New York, New York; and
- 3Department of Orthopaedic Surgery, School of Medicine, Showa University Hospital, Tokyo, Japan
| | - Michele Sarin
- 2Department of Orthopaedic Surgery, Spine Care Institute, Hospital for Special Surgery, New York, New York; and
| | - Jennifer Shue
- 2Department of Orthopaedic Surgery, Spine Care Institute, Hospital for Special Surgery, New York, New York; and
| | - Ellen M Soffin
- 2Department of Orthopaedic Surgery, Spine Care Institute, Hospital for Special Surgery, New York, New York; and
| | - Frank P Cammisa
- 2Department of Orthopaedic Surgery, Spine Care Institute, Hospital for Special Surgery, New York, New York; and
| | - Federico P Girardi
- 2Department of Orthopaedic Surgery, Spine Care Institute, Hospital for Special Surgery, New York, New York; and
| | - Andrew A Sama
- 2Department of Orthopaedic Surgery, Spine Care Institute, Hospital for Special Surgery, New York, New York; and
| | - Stephen Lyman
- 2Department of Orthopaedic Surgery, Spine Care Institute, Hospital for Special Surgery, New York, New York; and
| | - Alexander P Hughes
- 2Department of Orthopaedic Surgery, Spine Care Institute, Hospital for Special Surgery, New York, New York; and
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Lombardi AV, Byrd ZO, Berend KR, Morris MJ, Adams JB, Crawford DA. Mid-Term Survival of Total Hip Arthroplasty in Patients Younger Than 55-year-old. J Arthroplasty 2022; 37:S517-S523. [PMID: 35240281 DOI: 10.1016/j.arth.2022.02.092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 02/17/2022] [Accepted: 02/21/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Survivorship of total hip arthroplasty (THA) in younger patients is concerning given the inverse relationship between age and lifetime risk for revision. The purpose of this study is to determine if risk of revision has improved for patients aged 55 years or younger who undergo primary THA using modern polyethylene liners. METHODS A retrospective review identified 2,461 consented patients (2,814 hips) with minimum 2-year follow-up who underwent primary THA at our institution between September 2007 and August 2014 using components from a single manufacturer (Zimmer Biomet), all with vitamin E-infused highly crosslinked polyethylene acetabular inserts. There were 561 patients (643 THA; 23%) aged 55 or younger and 1,900 (2,171 THA; 77%) older than 55. RESULTS Mean follow-up was 5.0 years for both groups. There were more male patients in the younger (55%) than older (41%) group. Body mass index (BMI) was higher in younger patients independent of gender. Improvement in Harris hip score (HHS) was similar between groups. Kaplan-Meier survival to endpoint of all cause revision was similar between groups at 12 years (P = .8808) with 97.5% (95% CI: ±0.7%) for younger versus 97.1% (95% CI: ±0.6%) for older patients. Most frequent reason for revision overall was periprosthetic femoral fracture (21; 0.75%); univariate analysis revealed risk factors were female gender (P = .28) and age ≥65 years (P = .012). CONCLUSION Use of modern polyethylene, such as vitamin E-stabilized highly cross-linked, liners during THA may improve survivorship in younger patients undergoing THA. Younger patients undergoing primary THA with highly cross-linked polyethylene liners had no increased rate of revision at mid-term follow-up.
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Affiliation(s)
- Adolph V Lombardi
- Joint Implant Surgeons, Inc, New Albany, OH; White Fence Surgical Suites, New Albany, OH; Mount Carmel Health System, New Albany, OH; Department of Orthopaedics, The Ohio State University College of Medicine, Columbus, OH
| | - Zackary O Byrd
- Joint Implant Surgeons, Inc, New Albany, OH; White Fence Surgical Suites, New Albany, OH; Mount Carmel Health System, New Albany, OH
| | - Keith R Berend
- Joint Implant Surgeons, Inc, New Albany, OH; White Fence Surgical Suites, New Albany, OH; Mount Carmel Health System, New Albany, OH
| | - Michael J Morris
- Joint Implant Surgeons, Inc, New Albany, OH; White Fence Surgical Suites, New Albany, OH; Mount Carmel Health System, New Albany, OH
| | | | - David A Crawford
- Joint Implant Surgeons, Inc, New Albany, OH; White Fence Surgical Suites, New Albany, OH; Mount Carmel Health System, New Albany, OH
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Tuecking LR, Silligmann J, Savov P, Omar M, Windhagen H, Ettinger M. Detailed Revision Risk Analysis after Single- vs. Two-Stage Revision Total Knee Arthroplasty in Periprosthetic Joint Infection: A Retrospective Tertiary Center Analysis. Antibiotics (Basel) 2021; 10:antibiotics10101177. [PMID: 34680758 PMCID: PMC8533002 DOI: 10.3390/antibiotics10101177] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 09/13/2021] [Accepted: 09/23/2021] [Indexed: 01/03/2023] Open
Abstract
Periprosthetic joint infection (PJI) remains one of the most common causes of revision knee arthroplasty. Controversy continues to surround the proper operative technique of PJI in knee arthroplasty with single- or two-stage replacement. Significant variations are seen in the eradication rates of PJI and in implant survival rates. This detailed retrospective analysis of a single tertiary center is intended to provide further data and insight comparing single- and two-stage revision surgery. A retrospective analysis of all revision total knee arthroplasty (TKA) surgeries from 2013 to 2019 was performed and screened with respect to single- or two-stage TKA revisions. Single- and two-stage revisions were analyzed with regard to implant survival, revision rate, microbiological spectrum, and other typical demographic characteristics. A total of 63 patients were included, with 15 patients undergoing single-stage revision and 48 patients undergoing two-stage revision. The mean follow-up time was 40.7 to 43.7 months. Statistically, no difference was found between both groups in overall survival (54.4% vs. 70.1%, p = 0.68) and implant survival with respect to reinfection (71.4% vs. 82.4%, p = 0.48). Further, high reinfection rates were found for patients with difficult-to-treat organisms and low- to semi-constrained implant types, in comparison to constrained implant types. A statistically comparable revision rate for recurrence of infection could be shown for both groups, although a tendency to higher reinfection rate for single-stage change was evident. The revision rate in this single-center study was comparably high, which could be caused by the high comorbidity and high proportion of difficult-to-treat bacteria in patients at a tertiary center. In this patient population, the expectation of implant survival should be critically discussed with patients.
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Affiliation(s)
- Lars-Rene Tuecking
- Department of Orthopaedic Surgery, Hannover Medical School, Diakovere Annastift, Anna-von-Borries-Str. 1-7, 30625 Hannover, Germany; (L.-R.T.); (J.S.); (P.S.); (H.W.)
| | - Julia Silligmann
- Department of Orthopaedic Surgery, Hannover Medical School, Diakovere Annastift, Anna-von-Borries-Str. 1-7, 30625 Hannover, Germany; (L.-R.T.); (J.S.); (P.S.); (H.W.)
| | - Peter Savov
- Department of Orthopaedic Surgery, Hannover Medical School, Diakovere Annastift, Anna-von-Borries-Str. 1-7, 30625 Hannover, Germany; (L.-R.T.); (J.S.); (P.S.); (H.W.)
| | - Mohamed Omar
- Department of Trauma Surgery, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625 Hanover, Germany;
| | - Henning Windhagen
- Department of Orthopaedic Surgery, Hannover Medical School, Diakovere Annastift, Anna-von-Borries-Str. 1-7, 30625 Hannover, Germany; (L.-R.T.); (J.S.); (P.S.); (H.W.)
| | - Max Ettinger
- Department of Orthopaedic Surgery, Hannover Medical School, Diakovere Annastift, Anna-von-Borries-Str. 1-7, 30625 Hannover, Germany; (L.-R.T.); (J.S.); (P.S.); (H.W.)
- Correspondence: ; Tel.: +49-511-5354-0
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Schiffman CJ, Hannay WM, Whitson AJ, Neradilek MB, Matsen FA, Hsu JE. Impact of previous non-arthroplasty surgery on clinical outcomes after primary anatomic shoulder arthroplasty. J Shoulder Elbow Surg 2020; 29:2056-2064. [PMID: 32331844 DOI: 10.1016/j.jse.2020.01.088] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 01/13/2020] [Accepted: 01/21/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND The objectives of this study were to address the following questions regarding previous non-arthroplasty surgery prior to primary anatomic shoulder arthroplasty (either total shoulder arthroplasty [TSA] or ream-and-run arthroplasty): (1) To what degree is primary anatomic shoulder arthroplasty after prior non-arthroplasty surgery associated with inferior clinical outcomes and higher revision rates compared with arthroplasty without previous surgery? (2) Does type, approach, or timing of previous surgery affect outcomes after anatomic arthroplasty? METHODS A retrospective review of a primary shoulder arthroplasty database was performed and identified 640 patients undergoing anatomic shoulder arthroplasty (345 TSAs and 295 ream-and-run arthroplasties). Of these patients, 183 (29%) underwent previous non-arthroplasty surgery. Baseline and demographic information, 2-year postoperative outcome scores, and revision surgical procedures with associated culture results were collected. RESULTS In patients undergoing TSA, previous non-arthroplasty surgery was associated with a significantly lower 2-year Simple Shoulder Test (SST) score (P = .010), percentage maximum possible improvement (MPI) (P = .024), and Single Assessment Numeric Evaluation (SANE) score (P < .001) and a higher rate of reoperation (P < .001). In patients undergoing ream-and-run arthroplasty, previous non-arthroplasty surgery was associated with a nonsignificantly lower 2-year SST score, percentage MPI, and SANE score and higher reoperation rate. Prior fracture surgery carried a higher risk of reoperation than other types of surgery including rotator cuff repair and instability surgery. Among TSA and ream-and-run arthroplasty cases with prior non-arthroplasty surgery, prior open surgery and the time interval from most recent surgery were associated with nonsignificant differences in the 2-year SST score, percentage MPI, SANE score, and revision risk. CONCLUSION Previous surgery is associated with inferior clinical outcomes and higher revision rates in patients undergoing index TSA but not in those undergoing the ream-and-run procedure. Patients with previous fracture surgery carry the highest risk of reoperation.
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Affiliation(s)
- Corey J Schiffman
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, USA
| | - Willam M Hannay
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, USA
| | - Anastasia J Whitson
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, USA
| | | | - Frederick A Matsen
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, USA
| | - Jason E Hsu
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, USA.
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Dillon MT, Chan PH, Prentice HA, Burfeind WE, Yian EH, Singh A, Paxton EW, Navarro RA. The association between glenoid component design and revision risk in anatomic total shoulder arthroplasty. J Shoulder Elbow Surg 2020; 29:2089-2096. [PMID: 32507730 DOI: 10.1016/j.jse.2020.02.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 02/10/2020] [Accepted: 02/20/2020] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Anatomic total shoulder arthroplasty (TSA) is a proven treatment for glenohumeral joint osteoarthritis, with superior results compared with hemiarthroplasty. However, glenoid component loosening remains a problem and is one of the most common causes of failure in TSA. Multiple component designs have been developed in an attempt to reduce loosening rates. The purpose of this study was to evaluate risk of revision after anatomic TSA according to the glenoid component design. METHODS We conducted a cohort study including patients aged ≥18 years who underwent primary elective TSA for the diagnosis of osteoarthritis between 2010 and 2017. Patients with missing implant information, who received stemless humeral implants, or who received augmented glenoid implants, were excluded. Glenoid component designs used were categorized into 4 mutually exclusive treatment groups: polyethylene central-pegged ingrowth, polyethylene-metal hybrid, polyethylene all-cemented pegged, and polyethylene cemented keeled. Multivariable competing risk regression was used to evaluate the risk of glenoid loosening as a cause-specific revision by the glenoid component design. RESULTS Of the 5566 TSA included in the final cohort, 39.2% of glenoid implants were polyethylene central-pegged ingrowth, 31.1% were polyethylene-metal hybrid, 26.0% were polyethylene all-cemented pegged, and 3.6% were polyethylene cemented keeled. At 6-year final follow-up, 4.1% of TSA were revised for any cause, and 1.4% for glenoid loosening. Compared with the polyethylene central-pegged ingrowth design, no difference in glenoid loosening revision risk was observed for the polyethylene-metal hybrid design (hazard ratio [HR] = 1.15, 95% confidence interval [CI] = 0.42-3.20). However, both the polyethylene all-cemented pegged (HR = 2.48, 95% CI = 1.08-5.66) and polyethylene cemented keeled (HR = 3.84, 95% CI = 1.13-13.00) designs had higher risks for revision due to glenoid loosening. CONCLUSIONS We observed glenoid component designs to be associated with differential risks in revision due to glenoid loosening with polyethylene all-cemented pegged glenoids and polyethylene cemented keeled glenoids having higher risks when compared with polyethylene central-pegged ingrowth glenoids. Surgeons may want to consider the glenoid component design when performing anatomic TSA.
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Affiliation(s)
- Mark T Dillon
- Department of Orthopaedics, The Permanente Medical Group, Sacramento, CA, USA.
| | - Priscilla H Chan
- Surgical Outcomes and Analysis, Kaiser Permanente, San Diego, CA, USA
| | | | | | - Edward H Yian
- Department of Orthopaedics, Southern California Permanente Medical Group, Anaheim, CA, USA
| | - Anshuman Singh
- Department of Orthopaedics, Southern California Permanente Medical Group, San Diego, CA, USA
| | | | - Ronald A Navarro
- Department of Orthopaedics, Southern California Permanente Medical Group, Harbor City, CA, USA
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Lamb JN, Matharu GS, Redmond A, Judge A, West RM, Pandit HG. Risk Factors for Intraoperative Periprosthetic Femoral Fractures During Primary Total Hip Arthroplasty. An Analysis From the National Joint Registry for England and Wales and the Isle of Man. J Arthroplasty 2019; 34:3065-3073.e1. [PMID: 31353251 DOI: 10.1016/j.arth.2019.06.062] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 06/24/2019] [Accepted: 06/29/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The aim of this study is to estimate risk factors for intraoperative periprosthetic femoral fractures (IOPFF) and each anatomic subtype (calcar crack, trochanteric fracture, femoral shaft fracture) during primary total hip arthroplasty. METHODS This retrospective cohort study included 793,823 primary total hip arthroplasties between 2004 and 2016. Multivariable regression modeling was used to estimate relative risk of patient, surgical, and implant factors for any IOPFF and for all anatomic subtypes of IOPFF. Clinically important interactions were assessed using multivariable regression. RESULTS Patient factors significantly increasing the risk of fracture were female gender, American Society of Anesthesiologists grade 3 to 5, and preoperative diagnosis including avascular necrosis of the hip, previous trauma, inflammatory disease, pediatric disease, and previous infection. Overall risk of IOPFF associated with age was greatest in patients below 50 years and above 80 years. Risk of any fracture reduced with computer-guided surgery and in non-National Health Service hospitals. Nonposterior approaches increased the risk of shaft and trochanteric fracture only. Cementless implants significantly increased the risk of only calcar cracks and shaft fractures and not trochanteric fractures. CONCLUSION Fracture risk increases in patients younger than 50 and older than 80 years, females, American Society of Anesthesiologists grade 3 to 5, and indications other than primary osteoarthritis. Large cumulative reduction in IOPFF risk may occur with use of cemented implants, posterior approach, and computer-guided surgery. LEVEL OF EVIDENCE Level 3b (cohort study).
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Affiliation(s)
- Jonathan N Lamb
- Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), School of Medicine, University of Leeds, Chapel Allerton Hospital, Leeds, United Kingdom; Academic Department of Trauma & Orthopaedics, School of Medicine, University of Leeds, Leeds, United Kingdom
| | - Gulraj S Matharu
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom; Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, University of Oxford, Oxford, United Kingdom
| | - Anthony Redmond
- Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), School of Medicine, University of Leeds, Chapel Allerton Hospital, Leeds, United Kingdom; Leeds Musculoskeletal Biomedical Research Centre, Chapel Allerton Hospital, Leeds, United Kingdom
| | - Andrew Judge
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom; Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, University of Oxford, Oxford, United Kingdom
| | - Robert M West
- Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, United Kingdom
| | - Hemant G Pandit
- Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), School of Medicine, University of Leeds, Chapel Allerton Hospital, Leeds, United Kingdom; Academic Department of Trauma & Orthopaedics, School of Medicine, University of Leeds, Leeds, United Kingdom; Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, University of Oxford, Oxford, United Kingdom; Leeds Musculoskeletal Biomedical Research Centre, Chapel Allerton Hospital, Leeds, United Kingdom
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Namba RS, Inacio MCS, Pratt NL, Graves SE, Roughead EE, Paxton EW. Persistent Opioid Use Following Total Knee Arthroplasty: A Signal for Close Surveillance. J Arthroplasty 2018; 33:331-336. [PMID: 28974377 DOI: 10.1016/j.arth.2017.09.001] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 08/23/2017] [Accepted: 09/05/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Prolonged opioid use following total knee arthroplasty (TKA) has not been extensively studied. METHODS A cohort study of primary TKA for osteoarthritis using an integrated healthcare system and Total Joint Replacement Registry (January 2008-December 2011) was conducted. Opioid use during the first year after TKA was the exposure of interest and cumulative daily oral morphine equivalent (OME) amounts were calculated. Total postsurgical OME per 90-day exposure periods were categorized into quartiles. The end point was aseptic revision surgery. Survival analyses were conducted and hazard ratios (HRs) were adjusted for age, gender, prior analgesic use, opioid-related comorbidities, and chronic pain diagnoses. RESULTS A total of 24,105 patients were studied. After the initial 90-day postoperative period, 41.5% (N = 9914) continued to use opioids. Also, 155 (0.6%) revisions occurred within 1 year and 377 (1.6%) within 5 years. Compared to patients not taking any opioids, patients using medium-low to high OME after the initial 90-day period had a higher adjusted risk of 1-year revision, ranging from HR = 2.4 (95% confidence interval, 1.3-4.5) to HR = 33 (95% confidence interval, 10-110) depending on the OME and time period. CONCLUSION Patients who require opioids beyond 90 days after TKA warrant close follow-up.
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Affiliation(s)
- Robert S Namba
- Department of Orthopaedic Surgery, Southern California Permanente Medical Group, Irvine, California
| | - Maria C S Inacio
- Medicine and Devices Surveillance Centre of Research Excellence, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia
| | - Nicole L Pratt
- Medicine and Devices Surveillance Centre of Research Excellence, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia
| | - Stephen E Graves
- Australian Orthopaedic Association National Total Joint Replacement Registry, Adelaide, South Australia
| | - Elizabeth E Roughead
- Medicine and Devices Surveillance Centre of Research Excellence, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia
| | - Elizabeth W Paxton
- Surgical Outcomes and Analysis, Kaiser Permanente, San Diego, California
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Yao JJ, Maradit Kremers H, Schleck CD, Larson DR, Singh JA, Berry DJ, Lewallen DG. Patient-Reported Outcomes Can Be Used to Streamline Post-Total Hip Arthroplasty Follow-Up to High-Risk Patients. J Arthroplasty 2017; 32:3319-3321. [PMID: 28683979 DOI: 10.1016/j.arth.2017.05.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 05/11/2017] [Accepted: 05/15/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Patient-reported outcomes are increasingly used to capture the patients' perspective in total hip arthroplasty (THA). They can potentially be used to streamline post-THA follow-up to high-risk patients. We aimed to determine whether the long-term revision risk in THA relates to patient-reported measures at 2 and 5 years. METHODS In a single-institution cohort of primary THA procedures, we examined the association between 2-year and 5-year pain and Mayo Hip Scores and the risk of revision. RESULTS The absolute scores at 2 and 5 years were both significantly associated with the risk of revisions. Every 10-unit decline in the 2-year Mayo Hip Score <60 was associated with a significant 50% increase in the risk of revision (hazard ratio, 1.5 per 10 units; 95% confidence interval, 1.3-1.8). Similarly, every 10-unit decline in the 5-year Mayo Hip Score <60 was associated with almost doubling of the risk of revision (hazard ratio, 1.9 per 10 units; 95% confidence interval, 1.7-2.1). CONCLUSION We conclude that patient-reported outcomes in THA have prognostic importance and can be taken into account when planning frequency of aftercare. This will improve the efficiency of follow-up in large registry-based follow-up efforts.
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Affiliation(s)
- Jie J Yao
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Hilal Maradit Kremers
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota; Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Cathy D Schleck
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Dirk R Larson
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Jasvinder A Singh
- Division of Clinical Immunology and Rheumatology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Daniel J Berry
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - David G Lewallen
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
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Zywiel MG. CORR Insights(®): No Decrease in Knee Survivorship or Outcomes Scores for Patients With HIV Infection Who Undergo TKA. Clin Orthop Relat Res 2017; 475:472-4. [PMID: 27995556 DOI: 10.1007/s11999-016-5189-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Accepted: 11/22/2016] [Indexed: 01/31/2023]
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Mokka J, Mäkelä KT, Virolainen P, Remes V, Pulkkinen P, Eskelinen A. Cementless total hip arthroplasty with large diameter metal-on-metal heads: short-term survivorship of 8059 hips from the Finnish Arthroplasty Register. Scand J Surg 2014; 102:117-23. [PMID: 23820688 DOI: 10.1177/1457496913482235] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND AIMS Population-based register data from the National Joint Register of Australia and England and Wales have revealed that the mid-term outcome of cementless large diameter head metal-on-metal total hip arthroplasty is inferior to that of conventional cemented metal-on-polyethylene total hip arthroplasty. The aim of this study was to compare the results of cementless large diameter head metal-on-metal total hip arthroplasty with conventional cemented arthroplasty in Finland. The second aim of this study was to compare the cementless large diameter head metal-on-metal models with each other. MATERIAL AND METHODS Based on the data extracted from the Finnish Arthroplasty Register, the risk of revision of 8059 cementless large diameter head metal-on-metal total hip arthroplasties performed during 2002-2009 was analyzed using Cox regression model. The revision risk of these hips was compared to that of 16,978 cemented metal-on-polyethylene total hip arthroplasties performed during the same time period. RESULTS In the Cox regression analysis, there was no difference in revision risks between cementless large diameter head metal-on-metal total hip arthroplasty and cemented metal-on-polyethylene total hip arthroplasty (relative risk = 0.90, confidence interval = 0.74-1.10, p = 0.3). However, in female patients aged 55 years or above, cementless large diameter head metal-on-metal total hip replacements showed a significantly increased risk of revision as compared to cemented total hip replacements (relative risk = 1.33, confidence interval = 1.04-1.70). Compared to the reference implant in this study (cementless Synergy stem combined with Birmingham Hip Resurfacing [BHR] cup), the CementLess Spotorno (CLS) stem combined with Durom cup had a 2.9-fold (95% confidence interval = 1.17-6.90) increased risk of revision. CONCLUSIONS We found that cementless large diameter head metal-on-metal total hip arthroplasty had short-term survivorship compared with cemented total hip arthroplasty at a nation-wide level. However, in female patients aged 55 years or above, cementless large diameter head metal-on-metal total hip arthroplasty showed inferior results. Furthermore, implant design had an influence on revision rates. Longer follow-up time is needed to assess the success of large diameter head metal-on-metal total hip arthroplasty.
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Affiliation(s)
- J Mokka
- Department of Orthopaedics and Traumatology, Surgical Hospital, Turku University Hospital, Turku, Finland
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