Risk factors for infection, revision, death, blood transfusion and longer hospital stay 3 months and 1 year after primary total hip or knee arthroplasty

Rhee, Chanseok; Lethbridge, Lynn; Richardson, Glen; Dunbar, Michael J.

doi:10.1503/cjs.007117

Cited by 51 publications

(59 citation statements)

References 49 publications

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“…In our study, low preoperative Hb, CCF, ASA-PS (3), and GA were significantly independent risks for blood transfusion in TKA, which is consistent with the results of recently published studies. [20][21][22][23] However, none of them discussed the association between choice of anesthesia and the risk of blood transfusion events.…”

Section: Discussionmentioning

confidence: 99%

Association between Type of Anesthesia and Risk of Blood Transfusion Events in Primary Unilateral Total Knee Arthroplasty: A Secondary Analysis Based on a Cohort Study in Singapore

Zhu

Tong

2020

J Knee Surg

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This study evaluated whether the type of anesthesia independently related to risk of blood transfusion events in patients undergoing total knee arthroplasty (TKA) after adjusting for other covariates. This was a secondary analysis of a retrospective cohort study of patients undergoing primary unilateral TKA in Singapore. The independent variable was the type of anesthesia and the dependent variable was blood transfusion events. A multivariable logistic regression analysis was performed adjusting for variables that might affect the choice of anesthesia or blood transfusion events. Additional analyses examined this association by the subgroup analysis by using stratified multivariate logistic regression models. Of all 2,366 patients undergoing primary unilateral TKA, 120 (5.1%) developed blood transfusion events. Sixty-four (4.1%) of 1,560 patients with regional anesthesia (RA) developed blood transfusion events, compared with 56 (6.9%) of 806 patients with general anesthesia (GA; (p = 0.003). After adjusting for age, sex, preoperative hemoglobin, and other variables, patients who received RA had a decreased risk of blood transfusion events compared with those receiving GA (odds ratio [OR]: 0.53, 95% confidence interval [CI]: 0.35–0.81). This risk further decreased in male (OR: 0.20, 95% CI: 0.07–0.59) and participants whose operation time ≥ 90 minutes (OR: 0.39, 95% CI: 0.19–0.78). Our results indicated that patients receiving primary unilateral TKA who were managed with RA had a significantly decreased risk of blood transfusion events compared with those with GA, especially in male and participants whose operation time ≥ 90 minutes.

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Section: Discussionmentioning

confidence: 99%

Association between Type of Anesthesia and Risk of Blood Transfusion Events in Primary Unilateral Total Knee Arthroplasty: A Secondary Analysis Based on a Cohort Study in Singapore

Zhu

Tong

2020

J Knee Surg

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“…Revision rates were higher among patients with certain comorbid conditions like hypertension and those with paraparesis/hemiparesis. 9 However, no composite effect of minimally invasive posterolateral approach with larger head diameters are studied.…”

Section: Introductionmentioning

confidence: 99%

Survival analysis for all-cause revision following primary total hip arthroplasty with a medial collared, triple-tapered primary hip stem versus other implants in real-world settings

Chitnis

Mantel²,

Ruppenkamp

et al. 2020

Current Medical Research and Opinion

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“…Deep periprosthetic joint infection (PJI) following total knee arthroplasty (TKA) usually needs treatment by two-stage revision arthroplasty (2,3). It causes signi cant bone loss, as well as substantial injury to soft tissue structures and could necessitate higher-constraint prostheses with lower reported survivals (4); ergo, even the lowest infection rate is too high to be accepted by the surgeon or the patient after TKA and reducing infection rate has always been a challenge (3)(4)(5)(6). This is especially true in Iran, where heavy economic sanctions have caused revision devices and prostheses less available.…”

Section: Introductionmentioning

confidence: 99%

“…Much research has been carried out for prevention and also early detection of post-TKA infections (2,(5)(6)(7)(8)(9)(10). Regarding prevention, a recent topic is utilizing intrawound vancomycin powder.…”

Section: Introductionmentioning

confidence: 99%

Low Post-Arthroplasty Infection Rate is Possible in Developing Countries: Long-Term Experience of Local Vancomycin Use From A High-Volume Tertiary Knee Center in Iran

Tahmasebi

Vaziri

Vosoughi

et al. 2020

Preprint

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Background: Significant research has been carried out for prevention and also early detection of post-TKA infections. Regarding prevention, utilizing intrawound vancomycin powder in TKA surgery has yielded rather contrasting results in the pertinent literature. Regarding early detection, CDC criteria, although effective in general, are not specifically designed for post-TKA infections. Here, we present a 7-year experience of primary TKA in a high-volume tertiary knee center in Iran, during which intrawound vancomycin powder was used as a routine practice at the end of TKA surgeries. Also, new criteriae are proposed to detect suspected superficial post-TKA infections. Methods: This is a retrospective analysis of primary total knee arthroplasties performed in a tertiary knee center, from March 2011 to December 2018, by a single senior knee surgeon. All patients with follow-up periods of less than one year were excluded from the study. All patient received vancomycin (powder, 1gr) before water-tight closure of the joint capsule. Results: Altogether, 1710 patients were included in the study. Patients were mostly women (male to female ratio: 1 to 4), with a mean age of 64.99 (SD=11.49) years. The overall infection rate was 2.16% (37 of 1710 patients), including 5 periprosthetic deep joint infections and 32 suspected superficial wound infections. Of the 32 suspected superficial infections that were treated with a one-week course of oral antibiotics, all reported disappearance of symptoms, but 2 cases returned with late deep infection. All in all, 7 patients (0.41%) underwent two-stage knee arthroplasty due to deep joint infections. Conclusions: Our experience shows that by utilizing intrawound vancomycin for 7 years as a routine practice along with other measures, we were able to reach relatively low rates of deep post-TKA infections. Howbeit, randomized controlled trials are required to clarify the effect of intrawound vancomycin on post-TKA infection rate.

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Risk factors for infection, revision, death, blood transfusion and longer hospital stay 3 months and 1 year after primary total hip or knee arthroplasty

Abstract: We have identified the risk factors associated with higher rates of postoperative complications and longer hospital stay after TJR. The results enable individualized risk stratification during the preoperative consultation.

Cited by 51 publications

References 49 publications

Association between Type of Anesthesia and Risk of Blood Transfusion Events in Primary Unilateral Total Knee Arthroplasty: A Secondary Analysis Based on a Cohort Study in Singapore

Association between Type of Anesthesia and Risk of Blood Transfusion Events in Primary Unilateral Total Knee Arthroplasty: A Secondary Analysis Based on a Cohort Study in Singapore

Survival analysis for all-cause revision following primary total hip arthroplasty with a medial collared, triple-tapered primary hip stem versus other implants in real-world settings

Low Post-Arthroplasty Infection Rate is Possible in Developing Countries: Long-Term Experience of Local Vancomycin Use From A High-Volume Tertiary Knee Center in Iran

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