Outcomes Following Primary Total Hip or Knee Arthroplasty in Substance Misusers

Best, Matthew J.; Buller, Leonard T.; Klika, Alison K.; Barsoum, Wael K.

doi:10.1016/j.arth.2015.01.052

Cited by 72 publications

(53 citation statements)

References 24 publications

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“…Patients and outcomes were tracked for 90 d. Using previously described methodology; ICD-9 codes were used to identify complications[ 9 - 11 , 29 , 30 ]. The following outcomes were tracked: acute post-operative infection (998.5), osteomyelitis (730) and infection of orthopaedic device (996.66).…”

Section: Methodsmentioning

confidence: 99%

Season of the year influences infection rates following total hip arthroplasty

Rosas

Ong

Buller

et al. 2017

WJO

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AIMTo research the influence of season of the year on periprosthetic joint infections.METHODSWe conducted a retrospective review of the entire Medicare files from 2005 to 2014. Seasons were classified as spring, summer, fall or winter. Regional variations were accounted for by dividing patients into four geographic regions as per the United States Census Bureau (Northeast, Midwest, West and South). Acute postoperative infection and deep periprosthetic infections within 90 d after surgery were tracked.RESULTSIn all regions, winter had the highest incidence of periprosthetic infections (mean 0.98%, SD 0.1%) and was significantly higher than other seasons in the Midwest, South and West (P < 0.05 for all) but not the Northeast (P = 0.358). Acute postoperative infection rates were more frequent in the summer and were significantly affected by season of the year in the West.CONCLUSIONSeason of the year is a risk factor for periprosthetic joint infection following total hip arthroplasty (THA). Understanding the influence of season on outcomes following THA is essential when risk-stratifying patients to optimize outcomes and reduce episode of care costs.

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Section: Methodsmentioning

confidence: 99%

Season of the year influences infection rates following total hip arthroplasty

Rosas

Ong

Buller

et al. 2017

WJO

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“…To our knowledge, this is the first ten‐year cohort study to evaluate intravenous drug abuse as a risk factor for reinfection after reimplantation after PHI. Previous studies had reported increased infection rates of infection in patients with substance misusers undergone THA [3,22–25]. Drug abuser has been reported to be associated with a higher rate of infection, postoperative complications and mortality after THA.…”

Section: Discussionmentioning

confidence: 99%

Intravenous drug abuse is a risk factor in the failure of two‐stage treatment for infected total hip arthroplasty

Lin

Huang

et al. 2017

The Kaohsiung J of Med Scie

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Reinfection after two-stage revision hip arthroplasty (RHA) is still a complex issue. Only few studies revealed the factors affecting the success rate in the treatment of periprosthetic hip infection (PHI), especially risk factors. A retrospective study was conducted using records of 30 patients underwent two-stage RHA for infected total hip arthroplasty (THA). Treatment was defined as successful if a patient did not need any reoperation or invasive procedure such as image-guided drainage during the two years after reimplantation. Treatment was defined as failure if any surgery or invasive procedure or long-term antibiotic suppression was considered necessary to control infection. Four patients had infection recurrence defined as failed and three of them had intravenous drug abuse. Twenty-six patients had no infection recurrence at the end of follow-up and one of them had intravenous drug abuse but quitting after surgery. We suggest that once adequate cleaning up achieved, risk of reinfection may be little even in immunocompromised patients with RHA because of relative less old age than those with revisional total knee arthroplasty. Patients of the reinfection group were younger and non-obese with adequate nutritional status. We may consider intravenous drug abuse could take a great toll on health and lead to reinfection. Finally, we suggest performing the gold-standard two-stage reimplantation technique to manage cases with infection, educating drug abusers regarding the risk of surgical failure, and implementing a quitting program at least 1 year before the index surgery.

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“…Categorical variables were analyzed with the chi-square and/or the Fisher exact test, and multivariate logistic regression was performed to provide odds ratios (ORs) within a 95% confidence interval. As in previous studies that used large registries, only variables present in at least 2% of the population were utilized for the multivariate analysis 37 - 39 .…”

Section: Methodsmentioning

confidence: 99%

Coinfection with Hepatitis C and HIV Is a Risk Factor for Poor Outcomes After Total Knee Arthroplasty

Mahure

Bosco

Slover

et al. 2017

JBJS OA

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Background:As medical management continues to improve, orthopaedic surgeons are likely to encounter a greater proportion of patients who have coinfection with human immunodeficiency virus (HIV) and hepatitis-C virus (HCV).Methods:The New York Statewide Planning and Research Cooperative System (SPARCS) database was used to identify patients undergoing total knee arthroplasty between 2010 and 2014. Patients were stratified into 4 groups on the basis of HCV and HIV status. Differences regarding baseline demographics, length of stay, total charges, discharge disposition, in-hospital complications and mortality, and 90-day hospital readmission were calculated.Results:Between 2010 and 2014, a total of 137,801 patients underwent total knee arthroplasty. Of those, 99.13% (136,604) of the population were not infected, 0.62% (851) had HCV monoinfection, 0.20% (278) had HIV monoinfection, and 0.05% (68) were coinfected with both HCV and HIV. Coinfected patients were more likely to be younger, female, a member of a minority group, homeless, and insured by Medicare or Medicaid, and to have a history of substance abuse. HCV and HIV coinfection was a significant independent risk factor for increased length of hospital stay (odds ratio [OR], 2.9; 95% confidence interval [CI], 1.75 to 4.81), total hospital charges in the 90th percentile (OR, 2.02; 95% CI, 1.12 to 3.67), ≥2 in-hospital complications (OR, 2.04; 95% CI, 1.04 to 3.97), and 90-day hospital readmission (OR, 3.53; 95% CI, 2.02 to 6.18).Conclusions:Patients coinfected with both HCV and HIV represent a rare but increasing population of individuals undergoing total knee arthroplasty. Recognition of unique baseline demographics in these patients that may lead to suboptimal outcomes will allow appropriate preoperative management and multidisciplinary coordination to reduce morbidity and mortality while containing costs.Level of Evidence:Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

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Outcomes Following Primary Total Hip or Knee Arthroplasty in Substance Misusers

Cited by 72 publications

References 24 publications

Season of the year influences infection rates following total hip arthroplasty

Season of the year influences infection rates following total hip arthroplasty

Intravenous drug abuse is a risk factor in the failure of two‐stage treatment for infected total hip arthroplasty

Coinfection with Hepatitis C and HIV Is a Risk Factor for Poor Outcomes After Total Knee Arthroplasty

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