Risk factors for pressure ulcers from the use of a pelvic positioner in hip surgery: a retrospective observational cohort study in 229 patients

Abstract

Background: Intraoperatively acquired pressure ulcers are serious postsurgical complications requiring additional treatment, reoperation, and extended hospitalization. No study has investigated the frequency of the ulcers caused by compression with a pelvic positioner, which is used in hip surgeries to stabilize patients in the lateral decubitus position. Methods: This retrospective study investigated the risk factors and the frequency of the ulcers caused by the use of pelvic positioners in hip surgeries. The records of patients who underwent surgical procedures under general anesthesia at our institution between January 1, 2016 and March 31, 2018 were reviewed. The inclusion criterion for the assessment of risk factors was hip surgery in the lateral decubitus position stabilized by a pelvic positioner. The exclusion criteria were patients with trauma, missing data, or a pre-existing pressure ulcer. Finally,.the study included 229 patients (265 hip surgeries). All the patients were positioned in the lateral decubitus position with the assistance of either a pelvic positioner, which had a single support fixture located over the pubic symphysis or a double support fixture located over the bilateral anterior superior iliac spine. Intraoperatively acquired pressure ulcers were diagnosed when ulcers were absent on admission and the redness that was observed immediately after surgery remained after 24 h. Multivariate analysis was used to identify factors associated with an increased risk for ulcers. Results: Ulcers developed in 8 of 1810 (0.44%) patients who underwent orthopedic surgery. Seven of the 265 (2.64%) patients who underwent hip surgery in the lateral decubitus position stabilized by a pelvic positioner developed ulcers. All ulcers were located on areas of the body that were compressed by the pelvic positioner. After identifying controls for patient height (less than 154 cm), surgery duration (longer than 180 min), blood loss (more than 355 ml), and type of pelvic positioner used, we identified the independent risk factors for ulcers to be patient height < 154 cm (adjusted odds ratio, 12.8; p-value, 0.032) and the use of pelvic positioners with pubic bone support (adjusted odds ratio, 10.53; p-value, 0.047). Conclusion: The use of pelvic positioners with pubic bone support should be avoided in patients with a height of < 154 cm to decrease the risk of ulcers.

Frequency and risk factors of pressure injuries in clinical settings of affiliated to Tabriz University of Medical Sciences

“…In fact, the incidence of pressure injuries is higher in patients with limited mobility. Since the main cause of pressure injuries is related to prolonged pressure on the skin and subsequent lack of blood supply to the organ and this has been confirmed in most studies, it seems that immobility can be a predictor of this complication (Ramezanpour et al., 2018; Rashvand et al., 2020; Ueno et al., 2020).…”

Advanced, Imageless Navigation in Contemporary THA: Optimising Acetabular Component Placement

“…Pure anterior pelvic roll has been shown to influence cup anteversion to a greater extent than inclination [75]. It is accepted that major pelvic movement may have an effect on the final cup insertion position [85] through surgeon perceptual error. Given the common anterior roll mechanism seen, this consequently leads to an underestimation of cup anteversion [82], with the degree of error directly related to the magnitude of pelvic tilt [49,78,107].…”

“…How far does an average pelvis move during a routine, primary, THA? Several previous authors have attempted to quantify 'normal' ranges of unintended pelvic movement during THA [74,76,82,85] and then to propose acceptable 'cut offs' to define clinically-important variation [75]. Anterior (or posterior) pelvic tilt alters the position of the cup in the sagittal plane [111] which has a direct impact on version perception.…”

“…), simply tightening them further to increase the rigidity of support is also not without risk. In their recent 2020 publication, Ueno and colleagues demonstrated a 2.64% rate of medically-important soft tissue ulceration secondary to pelvic positioner use for routine primary THAs [85].…”

“…The process of mechanical cup reaming and implant impaction are obvious examples [84], but 'strong' traction from exposure-permitting retractors are also a recognised culprit [84,86]. While traction for safe exposure may be an unavoidable evil during primary THA, authors who have considered this important force mechanism recommend releasing or 'backing off ' retractor tension during the critical stage of definitive cup impaction [85], which may permit some measure of tilt correction [84]. The 2019 work of Della Valle et al however suggests that retractor removal is unlikely to facilitate complete correction of anterior roll which had been induced earlier during the case [82].…”