Severe Obesity Increases Risk of Infection After Revision Total Hip Arthroplasty

Bongers, Joris; Smulders, Katrijn; Nijhof, Marc W.

doi:10.1016/j.arth.2019.07.028

Cited by 12 publications

(4 citation statements)

References 29 publications

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“…Comparatively, previous studies reported conflicting effects of BMI on outcomes after rTHA, with some studies noting no association between obesity and postoperative morbidity and mortality, while others reporting worse outcomes and increased complications among obese patients. 7 - 9 , 17 Perhaps most notably, a larger database study of 18,866 patients by Roth et al 18 demonstrated a J-shaped curve between the relationship of increasing BMI and 30-day complications, with the lowest rate of complications occurring around a BMI of 30, with increasing complications as BMI increased. Overall, this study reinforces the mounting evidence suggesting that morbid obesity is a greater risk factor than obesity for adverse outcomes after rTHA.…”

Section: Discussionmentioning

confidence: 99%

“…By contrast, other small prospective cohort studies found increased rates of adverse events and worsened functional and pain-related outcomes in obese patients after rTHA. 7 - 9 Overall, the literature lacks consensus regarding the complication profile and economic outcomes among obese and morbidly obese patients during the immediate in-hospital period after rTHA, presenting a valuable addressable opportunity for perioperative risk stratification and optimization for this subset of patients.…”

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confidence: 99%

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The Impact of Morbid Obesity on In-hospital Outcomes after Revision Total Hip Arthroplasty: An Analysis of the National Inpatient Sample

et al. 2022

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Introduction: There remain limited data on the effect of obesity on in-hospital outcomes after revision total hip arthroplasty (rTHA). Methods: Discharge data from the National Inpatient Sample were used to identify patients undergoing rTHA from 2006 to 2015. Propensity score analysis was done to analyze the effects of obesity and morbid obesity on in-hospital economic and complication outcomes after rTHA. Results: The estimated 460,297 rTHAs were done during the study period. Obese patients were more likely to suffer from any complication than not obese patients (41.44% versus 39.41%, P = 0.0085), and morbidly obese patients were more likely to suffer from any complication than obese patients (47.22% versus 41.44%, P , 0.0001). Obesity was associated with increased risk of postoperative anemia compared with not obese patients, while morbid obesity was associated with increased risk of postoperative anemia, hematoma/seroma, wound dehiscence, and postoperative infection (P , 0.05). Morbidly obese patients also had a significantly greater average length of stay (6.40 days) than obese (5.23 days) and not obese (5.37 days) patients (P , 0.0001). Discussion: Although both obesity and morbid obesity are associated with higher risk of in-hospital postoperative complications after rTHA, morbid obesity is a larger risk factor and is associated with a longer length of stay.A lthough primary total hip arthroplasty (THA) has a well-reported track record of excellent outcomes, the number of patients requiring revision THA (rTHA) for reasons such as implant failure, metallosis, infection, and instability has steadily increased in recent decades. 1 In 2014, a total of 50,220 rTHAs were done, and the incidence of the procedure is

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

The Impact of Morbid Obesity on In-hospital Outcomes after Revision Total Hip Arthroplasty: An Analysis of the National Inpatient Sample

et al. 2022

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“…reported that rivaroxaban was associated with a higher risk of wound complications among 10 361 patients receiving TKA or THA when compared with LMWH. The differences in postoperative wound complications patterns may be related to the diversity of patients treated with total joint arthroplasty 47,48 . Thus, further studies are needed to assess the association between the use of NOACs and wound complications among THA and TKA patients with different risk factors for better prevention of these complications in clinical practice.…”

Section: Discussionmentioning

confidence: 99%

Wound complications and bleeding with new oral anticoagulants in patients undergoing total joint arthroplasty: A systematic review and meta‐analysis of randomized controlled trials

Wang

Xie

Zheng

et al. 2021

Brit J Clinical Pharma

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Aims The results of associations between new oral anticoagulants (NOACs) and wound complications after total joint arthroplasty remain inconsistent. We conducted a systematic review and meta‐analysis of randomized controlled trials to make comparisons with low molecular weight heparins (LMWH) on the clinical outcomes of total wound complications, together with other efficacy and safety endpoints to further evaluate the safety and efficacy of NOACs. Methods This meta‐analysis was conducted based on a published protocol (PROSPERO: CRD42019140841). We searched for available articles in PubMed, Embase and Cochrane Library through Jun 62 021. Random‐effects meta‐analyses, including subgroup analyses, were conducted to estimate the pooled relative risk (RR) and 95% confidence interval (CI) for specific doses of NOACs. Results We retrieved 1683 studies, of which 20 were eligible for inclusion. We found that apixaban was associated with a lower incidence of total wound complications compared with LMWH (RR = 0.81; 95% CI: 0.65–1.00), while dabigatran and rivaroxaban did not increase the risk of total wound complications. In addition, apixaban was associated with a reduction in the risk of major/clinically relevant nonmajor bleeding events compared to LMWH (RR = 0.80, 95% CI: 0.65–0.99), while rivaroxaban increased the risk for major/clinically relevant nonmajor bleeding events (RR = 1.23, 95% CI: 1.02–1.50). Moreover, all 4 NOACs were associated with lower incidences of major venous thromboembolism compared with LMWH. Conclusion A lower risk of wound complications was detected for apixaban, while dabigatran and rivaroxaban did not increase the risk when compared with LMWH. The efficacy of 4 NOACs was broadly similar.

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“…Beispielweise sind ein hohes Patientenalter, eine bekannte Sturzneigung und schlechte Knochenqualität ausschlaggebend, um eine zementierte Schaftrevision zu präferieren, da hiermit das peri- und postoperative Frakturrisiko reduziert werden kann und eine schnelle Vollbelastung möglich ist [ 1 ]. Als wichtige modifizierbare Faktoren sind ein Diabetes (Hämoglobin [Hb] A1c > 8), Adipositas, Rauchen, Anämie und Hypoalbuminämie (Serumalbumin < 3,5 g/dl) zu nennen [ 8 , 10 , 24 , 37 , 54 ]. Diese gilt es präoperativ zu erfassen und wenn möglich im Rahmen einer Prähabilitation zu optimieren, um das Komplikationsrisiko zu reduzieren.…”

Section: Operationsplanungunclassified

Strategien für die Schaftrevision

2022

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Zusammenfassung Hintergrund und Planung Die Schaftrevision stellt in ihrer Operationsvorbereitung und technischen Durchführung eine große Herausforderung dar. Die Ergebnisse sind maßgeblich von der Defektsituation, der Qualität der Implantatentfernung sowie der Wahl des Revisionsimplantates abhängig. Patientenspezifische Faktoren wie das Alter, die Komorbiditäten, die Knochenqualität oder auch die Lokalisation des Zementes haben entscheidenden Einfluss auf die operative Strategie. Eine entsprechende präoperative Vorbereitung inklusive des Vorhandenseins von notwendigen Spezialinstrumenten, die essenziell für die schonende Implantatentfernung sind, ist unabdingbar, um das bestmögliche Ergebnis zu erzielen. Therapie Die knochenschonende Explantation stellt gerade bei festsitzenden Schäften und Zementresten, die ggf. weit über den Isthmus reichen können, eine besondere Herausforderung dar. In solchen Situationen sollte ein transfemoraler Zugang erwogen werden. Die zementfreie Reimplantation unter Verwendung von modularen oder nichtmodularen Titanschäften ist für die meisten Revisionen die derzeit bevorzugte Therapie der Wahl. Bei älteren Patienten mit niedrigem Leistungsanspruch oder schlechter Knochenqualität bleibt die zementierte Versorgung eine gute alternative Therapieoption.

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Severe Obesity Increases Risk of Infection After Revision Total Hip Arthroplasty

Cited by 12 publications

References 29 publications

The Impact of Morbid Obesity on In-hospital Outcomes after Revision Total Hip Arthroplasty: An Analysis of the National Inpatient Sample

The Impact of Morbid Obesity on In-hospital Outcomes after Revision Total Hip Arthroplasty: An Analysis of the National Inpatient Sample

Wound complications and bleeding with new oral anticoagulants in patients undergoing total joint arthroplasty: A systematic review and meta‐analysis of randomized controlled trials

Strategien für die Schaftrevision

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