Early, Mid-Term, and Late-Term Aseptic Femoral Revisions After THA: Comparing Causes, Complications, and Resource Utilization

Schwarz, Julia; Lygrisse, Katherine A.; Roof, Mackenzie A.; Long, William J.; Schwarzkopf, Ran; Hepinstall, Matthew S.

doi:10.1016/j.arth.2021.05.041

Cited by 9 publications

(3 citation statements)

References 32 publications

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“…They conducted a retrospective study involving 208 patients who underwent aseptic femoral revision THA and found that revisions performed between 1 and 90 days and 91 days and 2 years (early and middle rTHAs) had longer hospital LOS compared with late rTHAs performed more than 2 years after pTHA. 11 The present study takes this one step further, involving 467 patients with failed pTHA and includes all revision types. To our knowledge, there are no other studies in the literature examining outcomes following rTHA based on time to revision.…”

Section: Discussionmentioning

confidence: 99%

Time to Revision Total Hip Arthroplasty Impacts Short-Term Outcomes Following Surgery

Lorentz,

Roof,

Christensen

et al. 2024

The Journal of Hip Surgery

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Previous reports have investigated the correlation between time to revision total hip arthroplasty (rTHA) and reason for revision, but little is known regarding the impact of timing on outcomes following rTHA. The purpose of this study is to evaluate the effect of time to rTHA on outcomes following rTHA. This retrospective observational study reviewed patients who underwent unilateral, aseptic rTHA at an academic orthopaedic hospital between June 2011 and April 2020 with at least 1-year of follow-up. Patients were categorized as early revisions if revised within 2 years of primary total hip arthroplasty (pTHA) or late revisions if revised after more than 2 years from pTHA. Patient demographics, surgical factors, and postoperative outcomes were compared. Multiple linear regression and binary logistic regression were used to determine significance of outcomes while controlling for confounding variables. Of the 467 cases, 150 underwent early revision and 317 underwent late revision. Early revisions experienced longer hospital length of stays (LOSs, days; 4.93 ± 3.93 vs. 3.28 ± 2.09; p < 0.001), all-cause 90-day readmission rates (11.3 vs. 12.7%; p = 0.032). Across all revision types, multivariate analysis revealed that time to rTHA (p < 0.001) and revision type (0.008) were found to be significant predictors of LOS while controlling for patient factors. Subanalyses within each revision type (femoral, acetabular, head/liner, and full) further reveal that time to rTHA is a significant independent predictor of LOS. Early revisions had a greater proportion of femoral revisions (44.0 vs. 15.5%), and late revisions had a greater proportion of head/liner (43.2 vs. 18.7%; p < 0.001) revisions. There were no significant differences between the two cohorts with respect to discharge disposition, surgical time, all-cause 90-day emergency department (ED) visits, re-revisions, and number of re-revisions. Patients undergoing aseptic rTHA within 2 years of index pTHA had longer LOS and greater rates of readmission. Time to rTHA is a significant independent predictor of LOS across and within all revision types and reason for revision aside from liner exchange and trunnionosis. No differences were seen in operative time, discharge disposition, re-revision, mortality, reoperation, and ED admission between early and late rTHAs across all revision subtypes. Level of evidence is III, retrospective observational analysis.

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Section: Discussionmentioning

confidence: 99%

Time to Revision Total Hip Arthroplasty Impacts Short-Term Outcomes Following Surgery

Lorentz,

Roof,

Christensen

et al. 2024

The Journal of Hip Surgery

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“…Periprosthetic fracture is the main cause for early femoral revision (34). A recent study by Alpaugh found that the risk of periprosthetic fractures increased when the femoral medullary cavity was paired with a smaller femoral prosthesis (35).…”

Section: Discussionmentioning

confidence: 99%

Accuracy and safety of a new Robotic arm for both femoral and acetabular side in Total Hip Arthroplasty: A Cadaveric Study

Zhang

Wang

et al. 2023

Preprint

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Background To investigate the accuracy and safety of a newly constructed robotic arm which can cover the whole process of THA, we performed a series of robot-assisted total hip replacement on the cadaver. Methods Fifteen frozen cadaveric specimens (30 hips) were used for this study. In this investigation, United hip system and Longwell robotic-assisted system were used. The entire lower limb was CT scanned prior to surgery. The 3D model was produced based on CT data, the site of the prosthesis, including acetabular anteversion, inclination angle, and the position of femoral prosthesis were planned. With the assistance of a robotic arm, the surgeon changed the parameters based on the preoperative plan and the actual condition during surgery, and completed the whole procedure. Following surgery, we measured the acetabular anteversion angle, acetabular inclination angle, femur anteversion angle, combined anteversion angle, stem angulation, and canal-fill-ratio. Results The parameters proved that the acetabular anteversion angle was 16.85 ± 3.00 °, and the acetabular inclination angle was 40.38 ± 5.37 °, femur anteversion angle was 15.90 ± 9.01 °, combined anteversion angle was 32.75 ± 9.03 °, stem angulation was 1.84 ± 0.99 °, leg length discrepancy was 2.47 ± 1.43mm. The canal-fill-rate (CFR) of femoral prosthesis was also satisfactory. Conclusion The accuracy and safety of this novel robotic arm are suitable for preparing both the acetabular and femoral sides, providing evidence for clinical trial.

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“…Periprosthetic fracture is one of the causes for early femoral revision [ 32 ]. A recent study by Alpaugh found that the risk of periprosthetic fractures increased when the femoral medullary cavity was paired with a smaller femoral prosthesis [ 33 ].…”

Section: Discussionmentioning

confidence: 99%

Accuracy and safety of a new robotic arm for both femoral and acetabular side in total hip arthroplasty: a cadaveric study

Lu,

Zhang,

Wang

et al. 2023

J Orthop Surg Res

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Background To investigate the accuracy and safety of a newly constructed robotic arm which can cover the whole process of THA, we performed a series of robot-assisted total hip replacement on the cadaver. Methods Fifteen frozen cadaveric specimens (30 hips) were used for this study. In this investigation, united hip system and Longwell robotic-assisted system were used. The entire lower limb was CT scanned prior to surgery. The 3D model was produced based on CT data; the site of the prosthesis, including acetabular anteversion, inclination angle, and the position of femoral prosthesis, was planned. With the assistance of a robotic arm, the surgeon changed the parameters based on the preoperative plan and the actual condition during surgery, and completed the whole procedure. Following surgery, we measured the acetabular anteversion angle, acetabular inclination angle, femur anteversion angle, combined anteversion angle, stem angulation, and canal fill ratio. Results The parameters proved that the acetabular anteversion angle was 16.85 ± 3.00°, the acetabular inclination angle was 40.38 ± 5.37°, femur anteversion angle was 15.90 ± 9.01°, combined anteversion angle was 32.75 ± 9.03°, stem angulation was 1.84 ± 0.99°, and leg length discrepancy was 2.47 ± 1.43 mm. The canal fill ratio (CFR) of femoral prosthesis of osteotomy line in sagittal section is 99.72 ± 1.54% and in coronal section is 62.94 ± 8.91%; below osteotomy line 2.5 cm in sagittal section is 100.00% and in coronal section is 81.48 ± 12.94%; below osteotomy line 7.5 cm in sagittal section is 59.51 ± 12.94% and in coronal section is 89.79 ± 11.13%; femoral shaft isthmus in sagittal section is 56.41 ± 13.80% and in coronal section is 84.95 ± 15.17%. Conclusion The accuracy and safety of this novel robotic arm are suitable for preparing both the acetabular and femoral sides, providing evidence for clinical trial.

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Early, Mid-Term, and Late-Term Aseptic Femoral Revisions After THA: Comparing Causes, Complications, and Resource Utilization

Cited by 9 publications

References 32 publications

Time to Revision Total Hip Arthroplasty Impacts Short-Term Outcomes Following Surgery

Time to Revision Total Hip Arthroplasty Impacts Short-Term Outcomes Following Surgery

Accuracy and safety of a new Robotic arm for both femoral and acetabular side in Total Hip Arthroplasty: A Cadaveric Study

Accuracy and safety of a new robotic arm for both femoral and acetabular side in total hip arthroplasty: a cadaveric study

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