Abstract
The objective of our study was to evaluate the association between acute periprosthetic joint infection (APJI) and radiographic measurement of soft-tissue thickness in elective total hip replacement surgery. A case-control study was conducted to compare the soft-tissue thickness radiographic measurement (SRM) at the hip in patients diagnosed with APJI based on Tsukayama et al. (2003) criteria after total hip replacement with patients that were not infected, at a single institution from 2013 to 2019. To minimize selection bias, each case was matched with two controls using the following methodology: patients of the same sex, with an age variation of 5 years, and nearest in surgery date to the cases were selected. All postoperative radiographs were performed in the first 24 h after total hip arthroplasty (THA) surgery as it is protocolized in our institution. Soft-tissue thickness radiographic measurement was defined as the distance from the tip of the greater trochanter to the skin following a perpendicular line to the femoral diaphysis in postoperative anteroposterior hip radiographs. In total, 78 patients were included (26 cases and 52 controls). The SRM median of the cases was 76.19 mm (SD: 26.518) and 53.5 mm (SD: 20.47) in controls. A multivariate logistic regression model showed an independent association between APJI and SRM (odds ratio (OR) 1.033, 95 % confidence interval (CI) 1.007–1.059, .012). Patients with an SRM greater than 60 mm had a 7-fold increase in the odds of APJI (OR 7.295, 95 % CI 2.364–22.511, .001). The results of our study suggest an association between large SRM at the hip and the risk of APJI in patients with primary total hip arthroplasty. SRM may be a helpful and easy tool for evaluating the risk of APJI before elective primary total hip replacement surgery.
Highlights
Acute periprosthetic joint infection following total hip arthroplasty (THA) can dramatically modify a patient’s postoperative expectations, increasing the challenge of postoperative management, sometimes even requiring revision surgery to eradicate infection and reconstruct a functional hip (Triantafyllopoulos et al, 2015).acute periprosthetic joint infection (APJI) cause an important adverse impact on patient outcomes and in healthcare economic systems
The objective of our study was to evaluate the association between acute periprosthetic joint infection (APJI) and softtissue thickness measured with an X-ray after elective total hip replacement surgery following the methodology previously described by Bernaus et al (2019)
A case-control study was conducted to compare soft-tissue thickness radiographic measurement (SRM) at the hip in patients diagnosed with APJI after total hip replacement with patients that were not diagnosed with APJI
Summary
Acute periprosthetic joint infection following total hip arthroplasty (THA) can dramatically modify a patient’s postoperative expectations, increasing the challenge of postoperative management, sometimes even requiring revision surgery to eradicate infection and reconstruct a functional hip (Triantafyllopoulos et al, 2015). APJIs cause an important adverse impact on patient outcomes and in healthcare economic systems. Prevalence estimations have predicted an increase in total hip replacement procedures in future years, and it is fitting to assume an increase in APJI. Host susceptibility to infection has emerged as an important predictor of APJI. Several risk factors for acute postoperative wound complications and infection following THA have previously been identified. These include diabetes, immunosuppression, inflammatory arthropathy, primary bone malignancy, prior lower-extremity fracture, renal or hepatic diseases, age, alcohol, parenteral drugs or tobacco abuse, vascular insufficiency, and obesity (Wright et al, 2012)
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