Complications After Revision Total Hip Arthroplasty in the Medicare Population

Badarudeen, Sameer; Shu, Albert C.; Ong, Kevin; Baykal, Doruk; Lau, Edmund; Malkani, Arthur L.

doi:10.1016/j.arth.2017.01.037

Cited by 135 publications

(82 citation statements)

References 24 publications

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“…The authors showed that elective TKAs are associated with a higher incidence and odds of in-hospital PEs than primary THAs. While many studies evaluated the perioperative mortality following THA and TKA [11], [12], only a few studies have touched on the impact of VTE as a sole cause of postoperative mortality in THAs and TKAs [13], [14]. This study investigated the incidence and risk factors of perioperative in-hospital mortality for TKA and THA patients who were complicated with VTE events.…”

Section: Discussionmentioning

confidence: 99%

What are the incidence and risk factors of in-hospital mortality after venous thromboembolism events in total hip and knee arthroplasty patients?

et al. 2018

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BackgroundPulmonary embolism and deep vein thrombosis, together referred to as venous thromboembolism (VTE), are serious and potentially preventable complications after total hip arthroplasty and total knee arthroplasty. The aim of this study was to investigate the incidence of mortality after VTE events and assess the risk factors that are associated with it.MethodsThe Nationwide Inpatient Sample was used to estimate the total number of total hip arthroplasty, total knee arthroplasty, VTE events, and mortality using the International Classification of Diseases, Ninth Revision procedure codes from 2003 to 2012. Patients' demographics, Elixhauser, and Charlson comorbidity indices were used to identify the risk factors associated with in-hospital VTEs and mortality.ResultsA total of 1,805,621 THAs and TKAs were included. The overall rate of VTE was 0.93%. The in-hospital mortality rate among patients with VTEs was 7.1% vs 0.30% in patients without VTEs (P-value < .0001). The risk factors for mortality after VTE events in descending order were as follows: hypercoagulable state (odds ratio [OR]: 5.3, 95% confidence interval [CI]: 3.6-5.8), metastatic cancer (OR: 5.2, 95% CI: 3.3-5.6), myocardial infarction (OR: 4.2, 95% CI: 2.3-4.7), peripheral vascular disease (OR: 3.6, 95% CI: 3.2-4.0), cardiac arrhythmias (OR: 3.2, 95% CI: 1.6-4.3), advanced age (OR: 3.1, 95% CI: 2.3-3.7), electrolyte disorders (OR: 3.1, 95% CI: 2.2-3.6), pulmonary circulation disorders (OR: 2.9, 95% CI: 2.6-3.3), depression (OR: 2.8, 95% CI: 1.6-3.4), complicated diabetes (OR: 2.7, 95% CI: 2.1-3.2), weight loss (OR: 2.6, 95% CI: 2.2-3.3), renal failure (OR: 2.6, 95% CI: 1.7-3.5), chronic pulmonary disease (OR: 2.5, 95% CI: 1.3-3.1), valvular disease (OR: 2.4, 95% CI: 1.8-2.7), liver disease (OR: 1.7, 95% CI: 1.2-1.9), and obesity (OR: 1.6, 95% CI: 1.5-1.9).ConclusionsIn-hospital VTE has a significant in-hospital mortality rate. Several of the identified risk factors in this study are modifiable preoperatively. We strongly urge the orthopaedic community to be cognizant of these risk factors and emphasize on optimizing patients' comorbidities before an elective arthroplasty.

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Section: Discussionmentioning

confidence: 99%

What are the incidence and risk factors of in-hospital mortality after venous thromboembolism events in total hip and knee arthroplasty patients?

et al. 2018

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“…However, in our case a late-onset dissociation occurred, five years after total hip replacement, making the case unique. The explantation of the well-fixed stem and re-implantation of a new uncemented or even cemented prosthesis may induce additional complications and risks10), such as excessive bone loss, increased intraoperative time and infection rate, increased blood loss and venous thromboembolic disease, increased rates of mortality and prolonged non-weight bearing period. Regarding the risk for a new disassembly, it is possible but the additional use of figure of eight wiring was intraoperatively and until 12 months postoperatively stable enough to guarantee short- and long-term hip stability.…”

Section: Discussionmentioning

confidence: 99%

Late Onset Disassembly of a Modular Neck-stem Component after Cementless Hip Replacement without Dislocation: A Case Report and Review of Literatures

et al. 2018

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Modular femoral prostheses are characterized by a second neck-stem junction. This modularity provides many clinical benefits including hip offset restoration, intraoperative leg length and anteversion adjustment. Although, this extra junction in modular femoral prostheses can contribute to catastrophic consequences like fracture, cold welding, corrosion and fretting of the modularity. However, only few complications related to the modularity itself have been reported in the literature. We report a unique case of neck-stem component dissociation without dislocation of the R-120PC™ Modular Stem (DJO Surgical). Our 71-year-old obese female patient underwent cementless hip replacement 5 years ago. Following radiographic confirmation of neck-stem dissociation open reduction was performed and wiring fixation was applied to secure the neck to the stem. After reduction and fixation, hip joint was stable, and our patient returned to her daily routine 2.5 months postoperatively. The last follow up was at 12 months after surgery with excellent radiographic and clinical evaluation.

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“…The incidence is unfortunately higher for revision THA (1.6 to 3.96% at 1–2 years; [5,6]) and revision TKA (0.9% in the first 30 days and 4.6% at 2 years [7,8•]). Furthermore, PJI is the most common reason for revision TKA and is the second most common reason for revision THA, accounting for 24–30% of TKA revision and 11–30% of THA revisions [5,9–11]. The morbidity of undergoing revision surgery for PJI should not be underestimated.…”

Section: Quantifying the Burden Of Periprosthetic Joint Infectionmentioning

confidence: 99%

Current Options and Emerging Biomaterials for Periprosthetic Joint Infection

et al. 2018

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Recent advancements in local antibiotic delivery platforms for preventing and treating PJI include titanium nanotube arrays, synthetic polymers, resorbable hydrogels, and cyclodextrin-based drug delivery options. In particular, cyclodextrins have facilitated great advancements in other clinical disorders and have demonstrated early promise as a future option in the arena of PJI. Novel treatment modalities for PJI optimize the implant surfaces to prevent bacterial biofilm formation or provide prolonged intra-articular antibiotic dosing to eradicate bacteria.

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Complications After Revision Total Hip Arthroplasty in the Medicare Population

Cited by 135 publications

References 24 publications

What are the incidence and risk factors of in-hospital mortality after venous thromboembolism events in total hip and knee arthroplasty patients?

What are the incidence and risk factors of in-hospital mortality after venous thromboembolism events in total hip and knee arthroplasty patients?

Late Onset Disassembly of a Modular Neck-stem Component after Cementless Hip Replacement without Dislocation: A Case Report and Review of Literatures

Current Options and Emerging Biomaterials for Periprosthetic Joint Infection

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