Primary Hip Arthroplasty Research Articles

Is There a Role for Extended Postoperative Oral Antibiotics in Primary Total Joint Arthroplasty High-Risk Individuals After Surgery for Periprosthetic Joint Infection?

With moderate level of evidence, 76% of delegates (super majority/strong consensus) of the most recent (2018) International Consensus Meeting on orthopedic infections agreed that extended oral antibiotics directed toward initial organisms after reimplantation for 3 months probably reduce the risk of failure due to periprosthetic joint infection. Nevertheless, the use of oral antibiotics becomes increasingly problematic with extended or long-term utilization. The development of antibiotic resistance and side effects are of particular concern, the most common being Clostridium difficile–associated diarrhea. Antibiotic stewardship is important when preventing and treating periprosthetic joint infection to hopefully prevent increase of bacterial antibiotic resistance. Two recent studies showed a significant difference in the incidence of surgical site infections after arthroplasty procedures in high-risk patients during short- and long-term follow-up without significant increase of adverse effects. However, another study showed no significant benefit of this practice. This summary discussed the details of those studies suggesting that the use of extended oral antibiotic prophylaxis in high-risk primary and revision hip and knee arthroplasty may reduce infection rates; nonetheless, additional higher level of evidence (level 1) is still needed to validate this practice as its potential adverse effects are not clear.

Procedures With Longer Intraoperative Times Undervalue Surgeon Work in Total Joint Arthroplasty: A Large, Nationwide Database Study.

Work relative value units (wRVUs) measure a surgeon's time and intensity required to perform the pre-service, intra-service, and post-service work of a surgical procedure and are commonly used to compare a physician's work between different procedures. Previous literature across multiple specialties report that longer, often revision, operations are undervalued when compared to primary procedures. Our study aims to analyze the differences in intra-operative time, and its corresponding wRVU/h between the Medicare benchmarks and real-world time-stamped data for total joint arthroplasty procedures. Thirteen primary and revision hip and knee arthroplasty procedures were identified, and intra-operative times were collected using the National Surgical Quality Improvement Program databases from 2014 to 2019. The Relative Value Scale Update Committee's (RUC) estimated median intra-operative times for each procedure was compared to the calculated median intra-operative times from National Surgical Quality Improvement Program, as were their corresponding wRVU/h. Procedures were additionally stratified by "long" (>110minutes) and "short" (≤110minutes) intra-operative times. The RUC over-estimated intra-operative time by 35.24% on average and this overestimation was more profound in longer operations than shorter operations (47.75% vs 15.22%, P= .011). The RUC intensity per unit time values (wRVU/h) between "long" and "short" procedures were significantly different (P<.001) and showed the undervaluation of intensity for the longer procedures by an average of 3.47 wRVU/h. Our study provides further evidence that physician work is undervalued in revision total hip and knee surgeries.

The role of serum D-dimer in the diagnosis of periprosthetic joint infection and timing of reimplantation.

D-dimer is a fibrin degradation product formed by the destruction of the cross-linked fibrin clot by activation of the coagulation system. Many studies have shown that systemic and local infections cause fibrinolytic activities. The purpose of this study was to determine the role of serum D-dimer in the diagnosis of periprosthetic joint infection (PJI) and the timing of reimplantation. The patients who underwent primary and revision knee or hip arthroplasty between July 2018 and May 2019 were prospectively evaluated. All surgeries were performed by the same surgeon. 60 of 71 patients who met our criteria were included in the study, comprising of 27 primary arthroplasties (PA), 21 two-stage septic revision (SR) and 12 aseptic revision (AR). We analyzed D-dimer, C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) levels. The values of the septic group were evaluated as two groups; Group 1 (before the first stage) and Group 2 (before the second stage) to investigate the role of D-dimer in determining the timing of reimplantation. D-dimer level was significantly higher in the SR group compared to PA and AR groups (p<0.001 and p=0.045). CRP and ESR levels were significantly higher in the SR group compared to PA and AR groups. There was no statistically significant difference between preoperative D-dimer levels of Group 1 and Group 2 (p=0.2). Serum D-dimer level can be used as an easy and inexpensive test to support the diagnosis of PJI. But the D-dimer level is not useful to determine the timing of reimplantation.

Outcome of revised metal-on-metal hip arthroplasties: a Dutch arthroplasty register study.

Preliminary results of metal-on-metal (MoM) hip arthroplasty were satisfactory, but since 2004 data showed high failure rates. National joint replacement registries are multi-centre databases comprised of thousands of subjects and implants which allow for identifying variables predictive of implant failure. The aim of the current study was to estimate re-revision rates after revision of a primary MoM hip arthroplasty in the Dutch Arthroplasty Register (LROI) and to assess potential predictor variables of re-revision of these MoM hip arthroplasties. Eligible procedures were those with a revision for any reason except infection, after an initial primary surgery with a hip resurfacing (HRA) or large-head MoM (LH-MoM) total hip arthroplasty (THA). The probability of re-revision for both types of MoM hip arthroplasty over time was estimated using the cumulative incidence function taking mortality as a competing risk into account. A proportional sub-distribution hazards regression model was used to assess potential predictor variables of re-revision of these MoM hip arthroplasties. A total of 3476 records of revised implants were included, of which 873 (25.2%) were MoM implants. Over the course of follow-up, 101 (11.5%) MoM implants were re-revised. During follow-up 36 (4.3%) patients who received a MoM-implant at primary arthroplasty and a revision afterwards had died. The regression model showed that for primary MoM implants a MoM articulation after revision (HR 2.48; 95% CI 1.53-4.03, p < 0.001), femoral-only revisions (HR 3.20; 95% CI 2.06-4.99, p < 0.001) and periprosthetic fractures (HR 1.98; 95% CI 1.03-3.82, p = 0.042) as reason for the first revision were statistically significant risk factors for re-revision. Both types of large-head MoM hip arthroplasties have shown high revision and re-revision rates; risk factors were identified. The outcome of this study can be helpful in managing expectations of patients and orthopaedic surgeons.

Demographic, Comorbidity, and Episode of Care Trends in Primary Hip Arthroplasty: 2008 to 2018

Abstract Background While previous studies have provided insight into time-trends in age and comorbidities of total hip arthroplasty (THA) patients, there is limited recent literature from within the past decade. The implication of these findings is relevant due to the projected THA volume increase and continued emphasis on healthcare system cost-containment policies. Therefore, the purpose of this study was to identify trends in THA patient demographics, comorbidities, and episode of care from 2008 to 2018. Methods The National Surgical Quality Improvement Program (NSQIP) was queried to identify patient demographics, comorbidities, and episodes of care outcomes in patients undergoing primary THA from 2008 to 2018 (n = 216,524). Trends were analyzed using analysis of variances for continuous variables, while categorical variables were analyzed using chi-squared or Monte Carlo tests, where applicable. Results From 2008 to 2018, there were no clinically significant differences in age and body mass index (BMI) in patients with BMI over 40 kg/m2. However, modifiable comorbidities including patients with hypertension (60.2% in 2008, 54.3 in 2018%, p &lt; 0.001) and anemia (19% in 2008, 11.2%, in 2016, p &lt; 0.001) improved. Functional status and the overall morbidity probability have improved with a decrease in hospital lengths of stay (4.0 ± 2.8 days in 2008, 2.1 ± 2.2 days in 2018, p &lt; 0.001), 30-day readmissions (4.2% in 2009, 3.3% in 2018, p &lt; 0.001), and significant increase in home-discharges (70.1% in 2008, 87.3% in 2018, p &lt; 0.001). Conclusion Patient overall health status improved from 2008 to 2018. While conjectural, our findings may be a reflection of a global shift toward value-based comprehensive care centering on patient optimization prior to arthroplasty, quality-of-care, and curtailing costs by mitigating perioperative adverse events.This study's level of evidence is III.

EFORT recommendations for off-label use, mix & match and mismatch in hip and knee arthroplasty.

Off-label use is frequently practiced in primary and revision arthroplasty, as there may be indications for the application of implants for purposes outside the one the manufacturers intended.Under certain circumstances, patients may benefit from selective application of mix & match. This can refer to primary hip arthroplasty (if evidence suggests that the combination of devices from different manufacturers has superior results) and revision hip or knee arthroplasty (when the exchange of one component only is necessary and the invasiveness of surgery can be reduced).Within the EFORT ‘Implant and Patient Safety Initiative’, evidence- and consensus-based recommendations have been developed for the safe application of off-label use and mix & match in primary as well as revision hip and knee arthroplasty.Prior to the application of a medical device for hip or knee arthroplasty off-label and within a mix & match situation, surgeons should balance the risks and benefits to the patient, obtain informed consent, and document the decision process appropriately.Nevertheless, it is crucial for surgeons to only combine implants that are compatible. Mismatch of components, where their sizes or connections do not fit, may have catastrophic effects and is a surgical mistake.Surgeons must be fully aware of the features of the components that they use in off-label indications or during mix & match applications, must be appropriately trained and must audit their results.Considering the frequent practice of off-label and mix & match as well as the potential medico-legal issues, further research is necessary to obtain more data about the appropriate indications and outcomes for those procedures. Cite this article: EFORT Open Rev 2021;6:982-1005. DOI: 10.1302/2058-5241.6.210080

A Comparison of Risks and Benefits Regarding Hip Arthroplasty Fixation.

Since the field-changing invention of noncemented hip arthroplasty fixation in the 1980s, noncemented fixation has been progressively replacing cemented fixation. However, analyses of fixation frequencies reveal new patterns in cement versus noncemented preferences. Although cementation is again gaining ground in the United States, noncemented models remain the dominant fixation mode, seen in more than 90% of all hip arthroplasties. This stark preference is likely driven by concerns regarding implant durability and patient safety. Although advances in surgical techniques, intensive perioperative care, and improved instrument have evolved in both methods, data from large arthroplasty registries reveal shifting risks in contemporary hip arthroplasty, calling the use of noncemented fixation into question. Varying risk profiles regarding sex, age, or health comorbidities and morphological and functional differences necessitate personalized risk assessments. Furthermore, certain patient populations, based on the literature and data from large registries, have superior outcomes from cemented hip arthroplasty techniques. Therefore, we wanted to critically evaluate the method of arthroplasty fixation in primary hip arthroplasties for unique patient populations.

The Main Trends in Hip Arthroplasty Based on the Data in the Vreden’s Arthroplasty Register from 2007 to 2020

This publication is the official report describing all total hip arthroplasty procedures registered in the database from 01.01.2007 to 31.12.2020. During this period, 74762 operations were performed: 67019 (89.64%) primary and 7743 (10.36%) revision. The proportion of males and females underwent primary arthroplasty was 41.1% and 59.0%, respectively. The age of patients with primary arthroplasty was 57.8 years (95% CI from 57.7 to 57.9), with revision 59.3 years (95% CI from 59.0 to 59.6). The absolute number of primary hip arthroplasty procedures added into the database increased annually from 2007 to 2012. Since 2015, there has been a trend towards a decrease in the number of hip arthroplasty, due to the more intensive growth in the number of knee replacements performed. The number of revision hip arthroplasty operations varies from year to year with a clear tendency to increase, except 2020. The large proportion of revisions are accounted for by early revisions performed in the first years after primary hip arthroplasty, as well as early re-revisions. The main types of implants fixation on primary arthroplasty during the reporting period were cementless (50.89%) and hybrid (32.33%). In patients of older age groups, there is a significant decrease in the proportion of cementless fixation, while the proportion of hybrid, reverse hybrid and cemented structures is increasing. There are significant fluctuations in the ratio of different types of implants fixation in different years.

Epidemiology of Hip And Knee Arthroplasty and Periprosthetic Joint Infection in Russian Federation

Background. Since there is no national arthroplasty registry in the Russian Federation, the exact number of arthroplasty operations performed is unknown. Aim of the study to evaluate the epidemiology of primary, revision hip and knee arthroplasty and periprosthetic joint infection in Russian Federation. Materials and Methods. The inquires were made to 85 subjects, 73 federal state budget institutions and 30 private hospitals. Results. Answers were received from 76 subjects of Russian Federation, 41 federal and 18 private hospitals. The studied indicators revealed to be pretty much heterogenic. The decrease of operations number from 20% to 40% in subjects of Russian Federation due to SARS-CoV-2 pandemic forced us to make no analysis for these 2020 indicators in Russian Federation generally. 147 061 primary hip and knee arthroplasties were performed in 2019 in Russian Federaion. 7 770 revison hip and knee arthroplasties were done. 6 606 cases of severe orthopaedic implant-assosiated infection were cured including 4 282 cases post hip and knee arthroplasties that constitutes 2,91 % from primary arthroplasties. Conclusions. The frequency of periprosthetic joint infection in Russian Federation correlates to the world data. High complexity for patients routing with implant-assosiated infection and strong demand for Federal Center of implant-assosiated orthopaedic infection are revealed.

Predicting the Exception-CRP and Primary Hip Arthroplasty.

Background: While primary hip arthroplasty is the most common operative procedure in orthopedic surgery, a periprosthetic joint infection is its most severe complication. Early detection and prediction are crucial. In this study, we aimed to determine the value of postoperative C-reactive protein (CRP) and develop a formula to predict this rare, but devastating complication. Methods: We retrospectively evaluated 708 patients with primary hip arthroplasty. CRP, white blood cell count (WBC), and several patient characteristics were assessed for 20 days following the operative procedure. Results: Eight patients suffered an early acute periprosthetic infection. The maximum CRP predicted an infection with a sensitivity and specificity of 75% and 56.9%, respectively, while a binary logistic regression reached values of 75% and 80%. A multinominal logistic regression, however, was able to predict an early infection with a sensitivity and specificity of 87.5% and 78.9%. With a one-phase decay, 71.6% of the postoperative CRP-variance could be predicted. Conclusion: To predict early acute periprosthetic joint infection after primary hip arthroplasty, a multinominal logistic regression is the most promising approach. Including five parameters, an early infection can be predicted on day 5 after the operative procedure with 87.5% sensitivity, while it can be excluded with 78.9% specificity.

Does obesity affect acetabular cup position, spinopelvic function and sagittal spinal alignment? A prospective investigation with standing and sitting assessment of primary hip arthroplasty patients

BackgroundTotal hip arthroplasty (THA) instability is influenced by acetabular component positioning, spinopelvic function and sagittal spinal alignment. Obesity is considered as a risk factor of THA instability, but the causal relationship remains unknown. This study aimed to investigate the influence of BMI on (1) spinopelvic function (lumbar flexibility, pelvic mobility and hip motion), (2) sagittal spinal alignment pre- and postoperatively and (3) acetabular cup position postoperatively in primary THA patients in a prospective setting.MethodsOne hundred ninety patients receiving primary total hip arthroplasty were enrolled in a prospective cohort study and retrospectively analysed. All patients received stereoradiography (EOS) in standing and relaxed sitting position pre-and postoperatively. C7-sagittal vertical axis (C7-SVA), lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), anterior plane pelvic tilt (APPT), and pelvic femoral angle (PFA) were assessed. Key parameters of the spinopelvic function were defined as lumbar flexibility (∆ LL = LLstanding − LLsitting), pelvic mobility (∆ PT = PTstanding − PTsitting) and hip motion (∆ PFA = PFAstanding − PFAsitting). Pelvic mobility was further defined based on ∆ PT as stiff, normal and hypermobile (∆ PT < 10°; 10°–30°; > 30°). The patients were stratified to BMI according to WHO definition: normal BMI ≥ 18.5–24.9 kg/m2 (n = 68), overweight ≥ 25.0–29.9 kg/m2 (n = 81) and obese ≥ 30–39.9 kg/m2 (n = 41). Post-hoc analysis according to Hochberg's GT2 was applied to determine differences between BMI groups.ResultsStanding cup inclination was significant higher in the obese group compared to the normal BMI group (45.3° vs. 40.1°; p = 0.015) whereas standing cup anteversion was significantly decreased (22.0° vs. 25.3°; p = 0.011). There were no significant differences for spinopelvic function key parameter lumbar flexibility (∆ LL), pelvic mobility (∆ PT) and hip motion (∆ PFA) in relation to BMI stratified groups. The obese group demonstrated significant enhanced pelvic retroversion compared to the normal BMI group (APPT − 1.8° vs. 2.4°; p = 0.028). The preoperative proportion of stiff pelvic mobility was decreased in the obese group (12.2%) compared to normal (25.0%) and overweight (27.2%) groups. Spinal sagittal alignment in C7-SVA and PI-LL mismatch demonstrated significantly greater imbalance in the obese group compared to the normal BMI group (68.6 mm vs. 42.6 mm, p = 0.002 and 7.7° vs. 1.2°, p = 0.032, respectively) The proportion of patients with imbalanced C7-SVA was higher in the obese (58.5%) than in the normal BMI group (44.1%).ConclusionsThe significantly increased spinal sagittal imbalance with altered pelvic mechanics is a potential cause for the reported increased risk of THA dislocations in obese patients. Consequently, the increased spinal sagittal imbalance in combination with normal pelvic mobility need to be taken into account when performing THA in obese patients.

Litigation after primary total hip and knee arthroplasties in France: review of legal actions over the past 30years.

Since the law of March 4, 2002, several modifications have impacted medical practices and their medico-legal implications. In case of an infectious complication not related to a fault of the practitioners (surgeons, anesthetists), the patient has the right to compensation assumed by the care structures. Moreover, the lack of preoperative information is no longer just a failing of the ethical standards but a breach of medical and legal obligations. Then, aims of this study were: (1) to describe the reasons for a lawsuit in France following total primary hip (THA) and total knee (TKA) arthroplasties and (2) to compare litigation characteristics of private and public practices. Civil (private practice) and administrative (public practice) court decisions in France between 1990 and 2020 were collected using the two main legal data sources (Legifrance, Doctrine). Eighty-three TKA and 173 THA cases were identified. Reasons for complaint in primary THA were mainly infection (29%), prosthetic failures (18%), nerves injuries (17%), and leg length discrepancies (11%). The main grounds for complaint in favor of the plaintiff were diagnostic or indication mistakes (100%), infections (80%), especially if a lack of information was recognized (88%). Reasons for complaint following primary TKA were mainly infections (65%) and persistent pain or stiffness (12%). Whatever the reason, the verdict was in favor of the plaintiff in about 2/3 of the cases. THAs were more at risk of appeal in administrative procedures than in civil (p = 0.008). There were more cases of implant failure in civil proceedings (p = 0.008). Indemnities after primary THA was higher in public activity litigation (p = 0.04). There were no differences in verdicts, grounds for complaints, and compensation between public and private practices for primary TKA. The main complaint about all the arthroplasties in France was a septic complication. The lack of information could be an added pejorative element for the final verdict.

535 Are Routine Post-Operative Blood Tests Necessary Following Hip or Knee Arthroplasty in Fit and Well Patients?

Abstract Introduction Enhanced recovery protocols in hip and knee arthroplasty have achieved same-day discharge in selected patients. However, abnormal serum sodium, haemoglobin and creatinine may affect postoperative management. In particular, Serum creatinine guides dosage of prophylactic direct oral anticoagulants (DOAC). In this study we aim to establish if post-operative blood tests following arthroplasty might affect management. Method Patients undergoing primary hip and knee arthroplasty surgery at our unit between April 2018 and March 2019 were included. National Joint Registry input forms were used to identify the patients and their American Society for Anaesthesiologists (ASA) grade. Patients with an ASA grade of 1 or 2 were included. The incidence of AKI, hyponatraemia, drop in haemoglobin below 80g/L (the threshold for consideration of transfusion) and altered DOAC dose were recorded. For statistical analysis, the z-test of single proportion was used to compare results to a hypothesised expected population proportion of 1% for group sizes greater than 10. The p-value was set to 0.05. Results Results leading to a change in management were seen in 19 of the 218 patients (8.7%) (p &amp;lt; 0.0001). Twelve patients (5.5%) developed stage 1 or 2 AKI (p &amp;lt; 0.0001). Three patients required a reduction in the DOAC dose in response to their post-operative creatinine result. Post-operative haemoglobin level was below 80 g/L in two patients. Hyponatraemia was observed in one fifth of the patients and required intervention in two patients. Conclusions Post-operative blood tests are essential prior to discharge for all patients following hip and knee arthroplasty, regardless of pre-operative status.

1526 Primary Hip and Knee Arthroplasty Documentation: Do Our Operation Notes Follow New GIRFT/BOA Guidelines? A Closed Loop Audit

Abstract Aim Operation notes provide essential information about the techniques and implants used in surgery. Accurate documentation is important to improve patient outcomes and reduce rising litigation costs within the NHS. The aim of this audit was to assess compliance to recent guidance for hip and knee arthroplasty documentation, issued by the Getting It Right First Time (GIRFT) programme in 2019. Method Data was collected retrospectively from operation notes of all primary total/unicompartmental knee and hip arthroplasties during August 2019 and again in October 2019 at a DGH. Documentation was audited against data items from the GIRFT knee and hip arthroplasty ‘best practice’ guidelines. Interventions between timeframes included clinician education and a discussion of the guidelines between local surgeons. Results In audit rounds 1 and 2 twenty-six and 34 patients had THRs and 23 and 28 had knee arthroplasties respectively. 100% compliance was seen in 5/23 THR criteria and 9/27 knee criteria. Average compliance for knee documentation rose from 71% to 74% but no improvement was seen for THR (68% vs 64%). Those with least improvement related to assessment of range of movement and vascular status at the end of surgery. Conclusions Although compliance was good against the majority of data points there was minimal change following a local education intervention. The development and use of fully compliant departmental operation note templates would provide further clarity about steps performed and surgeon rationale should patient care later be scrutinised. The template would also act as an invaluable educational tool for trainees reflecting on the case.

Enhanced Recovery Program: Does Preoperative Education Reduces Length of Hospital Stay in Primary Hip and Knee Arthroplasty?

IntroductionTotal knee and hip arthroplasty significantly improve the quality of life in people suffering from end-stage hip and knee arthritides. Enhanced recovery programs have shown improved outcomes following elective arthroplasty by decreasing patients’ anxiety, postoperative pain and reducing the length of hospital stay (LOS). The aim of our study is to evaluate the impact of preoperative education programs on LOS in patients undergoing hip and knee arthroplasty.MethodsRetrospective data was collected from a consecutive series of 520 patients’ charts and the Irish National Orthopaedic Register (INOR) for those who underwent hip or knee arthroplasty from January 1, 2018 to December 31, 2018 in our hospital. The LOS study compared 226 patients in the Educational Group (EG) who attended the Hip & Knee School (Preoperative Education Class) with 294 patients in the Conventional Group (CG) who did not attend the hip and knee educational program. ResultsWe identified that LOS decreased to 5.2 days in EG from 5.5 days in CG (p-value equals 0.26, statistically insignificant, t = 1.1093, df = 518), with a mean difference of only 0.3 days (95% CI). ConclusionPreoperative education does not reduce the LOS in primary hip and knee arthroplasty.

Mid-term outcomes of tantalum cup\u2013 a single centre study

IntroductionThe cementless acetabular implants are commonly used in primary and revision hip arthroplasty. Reconstruction of acetabulum in case of bone defects can be challenging. The aims of this single center study are to review the mid-term outcomes of porous tantalum cups (TM) and evaluate complications.MethodsThe midterm outcome of a trabecular metal tantalum modular uncemented cup was evaluated in 59 hips in 58 patients. In our group, we had 23 males and 35 females. The mean age was 70.11 years (range, 30 to 87 years). Four patients were lost to follow-up and 13 died during the period without having further surgeries attributed to the hip arthroplasty. The remaining 41 patients (42 revision hip arthroplasties) had complete data available.ResultsThe mean follow-up was 87 months, ranging from 24 to 144 months. Standard pelvic anteroposterior (AP) radiographs were used to assess and preoperatively classify acetabular defects as per Paprosky classification. The serial radiographs showed excellent stability, bone opposition and graft incorporation. Four patients had further surgeries. Two of these were due to infection (one superficial and one deep infection). One of the patients had washout and then removal of metal work, the other patient only had a washout and symptoms settled. One patient had vascular compromise and went for surgery to stem the bleeding. One patient had re-revision due to stem loosening and hence required surgery but the revision cup remained stable. We noted a 96% survival at an average of 7.2 years follow-up.ConclusionThe mid-term results with the trabecular metal cementless cup appeared to be promising in both primary and revision hip arthroplasty, even in the presence of considerable bone loss which requires bone grafting and augments.Level of evidenceIV.

Study the Results of Antibiotic Prophylactic Protocol Adopted by Ain Shams University Hospitals for reducing the Risk of Surgical Site Infection in Patients undergoing Hip Arthroplasty, Pilot Study

Abstract Background Total hip arthroplasties are well-proven solutions in case of end-stage osteoarthritis of the hip joint. Although, presence of complications can be devastating for the patient, especially periprosthetic joint infection (PJI). To prevent PJI, antibiotic prophylaxis regimens are regularly used. Objectives To study the association of antibiotic choice, duration and dosage with prevalence of surgical site infection among patients with hip arthroplasty and identify risk factors for surgical site infection in patient with hip arthroplasty. Patients and Methods After obtaining the hospitals Research/Ethics Committee approval and written informed consents from the patients, this study was carried on. 30 patients with primary hip arthroplasty surgery and all operations were performed by senior staff members. All patients were screened for suitability by detailed clinical assessment of their history and physical examination as well as radiological investigations. Results The result of this study was that we have 2 cases infected from 30 cases with percent of infection among patient with primary hip arthroplasty is 6.7% and by studying the risk factors for infection there was no specific risk factor for infection except for patient with cardiac disease have increased risk of infection. Conclusion In conclusion, this study postulated that systemic antibiotic prophylaxis delivered preoperatively in primary THA procedures significantly reduces the incidence of infection. There is no significant difference in the efficacy of cephalosporins compared with that of quinolones. Prophylactic antibiotics should be taken IV before skin incision by 30-60 minutes and no need for antibiotics more than 24 hours after operation.

Transfusion in orthopaedic surgery : a retrospective multicentre cohort study.

AimsOrthopaedic surgeries are complex, frequently performed procedures associated with significant haemorrhage and perioperative blood transfusion. Given refinements in surgical techniques and changes to transfusion practices, we aim to describe contemporary transfusion practices in orthopaedic surgery in order to inform perioperative planning and blood banking requirements.MethodsWe performed a retrospective cohort study of adult patients who underwent orthopaedic surgery at four Canadian hospitals between 2014 and 2016. We studied all patients admitted to hospital for nonarthroscopic joint surgeries, amputations, and fracture surgeries. For each surgery and surgical subgroup, we characterized the proportion of patients who received red blood cell (RBC) transfusion, the mean/median number of RBC units transfused, and exposure to platelets and plasma.ResultsOf the 14,584 included patients, the most commonly performed surgeries were knee arthroplasty (24.8%), hip arthroplasty (24.6%), and hip fracture surgery (17.4%). A total of 10.3% of patients received RBC transfusion; the proportion of patients receiving RBC transfusions varied widely based on the surgical subgroup (0.0% to 33.1%). Primary knee arthroplasty and hip arthroplasty, the two most common surgeries, were associated with in-hospital transfusion frequencies of 2.8% and 4.5%, respectively. RBC transfusion occurred in 25.0% of hip fracture surgeries, accounting for the greatest total number of RBC units transfused in our cohort (38.0% of all transfused RBC units). Platelet and plasma transfusions were uncommon.ConclusionOrthopaedic surgeries were associated with variable rates of transfusion. The rate of RBC transfusion is highly dependent on the surgery type. Identifying surgeries with the highest transfusion rates, and further evaluation of factors that contribute to transfusion in identified at-risk populations, can serve to inform perioperative planning and blood bank requirements, and facilitate pre-emptive transfusion mitigation strategies.Cite this article: Bone Jt Open 2021;2(10):850–857.

Dual-Mobility Progressive Press-Fit Hemispherical Acetabular Cup in Primary Hip Arthroplasty: Safety and Efficacy. The SYMCOR-1 study [NCT04209374

Purpose: To Estimate the short-term clinical safety and efficacy of hemispherical with flattened pole chromium-cobalt metal back dual-mobility acetabular cup with porous outer coating (HFPC-DM-HA), in primary THA. Methods: Single-center retrospective observational cohort study of consecutive patients undergoing THA with a HFPC-DMHA cup 2 years prior to study start. Prospective 2-year follow-up with letter and phone questionnaires. Results: Sampling frame: 361 patients including 59 patients (16.3%) in the cohort. 6 patients (10%) lost to follow-up. Median age 77.5 years (67, 92), 32% female, median BMI 25.2 kg.m-2 (18.4 to 56.8). Primary osteoarthritis in 80%. Median follow-up 3.0 years (2.7 to 4.1) Primary Endpoint: 2-year implant survival rate: 97% [87, 99]. Prosthetic dislocation: 0%. Secondary Endpoint: Modified HHS (pain &amp; functional sub score) improved from baseline 39.7 [34.6, 44.7] to 75.8 [72.1, 79.6] at 1-year and to 86.7 [83.7, 89.7] at 2-year (p&lt;0.0001). Conclusions: The short-term benefit-risk balance was deemed satisfactory

The role of routine postoperative laboratory tests following hip hemiarthroplasty for an elderly femoral neck fracture

BackgroundPerforming postoperative laboratory tests following joint arthroplasty is a regular practice. However, the role of routine postoperative laboratory tests in primary hip arthroplasty is currently in doubt. This study aimed to assess the role of routine postoperative laboratory tests for femoral neck fractures in elderly patients who underwent hip hemiarthroplasty and to evaluate the risk factors for postoperative laboratory testing abnormalities and related interventions.MethodsThis retrospective study reviewed 735 consecutive patients with femoral neck fractures (FNFs) who underwent hip hemiarthroplasty at a single tertiary academic organization. Patient characteristic features and laboratory testing values were recorded. Logistic regression models were calculated to identify risk factors.ResultsA total of 321 elderly patients (> 75 years of age) were ultimately enrolled for analysis. Abnormal postoperative laboratory tests were found in 265 patients (82.6%). Only a minority of the included patients (7.5%) needed medical intervention to treat postoperative laboratory testing abnormalities. Multivariate logistic regression analysis reported that a higher Charlson comorbidity index (CCI) (P = 0.03), abnormal preoperative haemoglobin level (P < 0.01), higher intraoperative blood loss (P < 0.01) and less frequent tranexamic acid use (P = 0.05) were risk factors for abnormal postoperative laboratory tests. Furthermore, a higher CCI has been identified as a risk factor for patients needing clinical interventions related to laboratory abnormalities.ConclusionsBecause 92.5% of laboratory tests did not influence postoperative management, the authors suggest that routine laboratory tests after hip hemiarthroplasty for FNFs are less instructive for the majority of elderly patients. Nevertheless, for patients with identified risk factors, postoperative laboratory tests are still required to identify the abnormalities that need to be managed.