Two Classifications for Surgical Wound Hematoma After Total Hip Replacement

Abstract

Objective:To determine the reliability of two classification methods for wound hematoma after total hip replacement. Methods:This prospective cohort study was conducted on patients who underwent total hip replacement for hip osteoarthritis between May 2014 and April 2015. Epidemiological, surgical, and functional data were assessed. Two experienced hip surgeons evaluated 75 pictures of wounds taken 24 hours after surgery. Both evaluators performed the analysis twice, with a 6-week interval between the two analyses. The subjective classification was divided into four different categories describing the hematoma: absent, mild, moderate, and severe. The objective classification was derived from mathematical calculation of the area of the hematoma using a grid superimposed on a picture of the wound. Results:The subjective classification demonstrated an intra-rater agreement of more than 70%, while kappa values showed poor to moderate inter-rater reliability. The objective classification based on mathematical measurements of the hematoma area was more reliable, with good to excellent intra- and inter-rater reliability. Conclusion:The objective classification demonstrated higher intra- and inter-rater reliability. The classification methods used in this study could serve as a useful instrument for orthopedic surgeons, researchers, and health care providers when assessing wound hematomas after total hip replacement. Level of Evidence II; Development of diagnostic criteria on consecutive patients (with universally applied reference ‘‘gold’’ standard).

Incidence, Risk Factors, and Subsequent Complications of Postoperative Hematomas Requiring Reoperation After Primary Total Hip Arthroplasty

“…A postoperative hematoma is a possible complication after THA [ 2 , 3 ]. Although uncommon, this complication can have substantial consequences, such as persistent wound drainage and infection [ 2 , 4 ]. Using NSQIP, our study aimed to identify the incidence, predictors, and the subsequent associated clinical complications of postoperative hematomas requiring reoperation after primary THA.…”

“…One previous study found that 0.41% of patients required surgical intervention to treat postoperative hematoma after primary THA [ 3 ]. Although rare, this complication can be catastrophic, resulting in persistent wound drainage, excessive pain, neurological impairment, infection, and even death [ 2 , 4 ].…”

The correlates of post-surgical haematoma in older adults with proximal femoral fractures

“…In studying factors related to a haematoma, we consider the US technique likely a strength so that we could carefully detect the presence and size of haematoma, thus overcoming the clinical disagreement between surgeons. In addition, the comprehensive geriatric assessment could be an additional study’s strength, offering the possibility to explore the role of non canonical factors potentially involved in the development of haematoma, despite biological plausibility [ 24 ].…”

Postoperative Fluid Collections in Total Joint Arthroplasty: A Narrative Review

“…Future technology will likely become more common to help diagnose a POFC. Fagotti et al 71 studied the reliability of two hematoma classification systems in THA. Their objective classification systems, which employed a dedicated computer algorithm, demonstrated improved accuracy in classifying the severity of hematomas in arthroplasty.…”