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《The Journal of arthroplasty》2022,37(3):574-580
BackgroundDiagnosing early periprosthetic joint infection (PJI) after primary total hip arthroplasty (THA) remains challenging. We sought to validate optimal laboratory value cutoffs for detecting early PJIs in a series of primary THAs from one institution.MethodsWe retrospectively identified 22,795 primary THAs performed between 2000 and 2019. Within 12 weeks, 43 hips (43 patients) underwent arthrocentesis. Patients were divided into 2 groups: evaluation ≤6 weeks or 6-12 weeks following THA. The 2011 Musculoskeletal Infection Society major criteria for PJI diagnosed PJI in 15 patients. Mann-Whitney U-tests were used to compare median laboratory values and receiver operating characteristic curve analysis was used to evaluate optimal cutoff values.ResultsBoth within 6 weeks and between 6 and 12 weeks postoperatively, median C-reactive protein (CRP), erythrocyte sedimentation rate, synovial white blood cell (WBC) count, neutrophil percentage, and absolute neutrophil count (ANC) values were significantly higher in infected THAs. Optimal cutoffs within 6 weeks were: CRP ≥100 mg/L, synovial WBCs ≥4390 cells/μL, neutrophil percentage ≥74%, and ANC ≥3249 cells/μL. Between 6 and 12 weeks, optimal cutoffs were: CRP ≥33 mg/L, synovial WBCs ≥26,995 cells/μL, neutrophil percentage ≥93%, and ANC ≥25,645 cells/μL.ConclusionEarly PJI following THA should be suspected within 6 weeks with CRP ≥100 mg/L or synovial WBCs ≥4390 cells/μL. Between 6 and 12 weeks postoperatively, cutoffs of CRP ≥33 mg/L, synovial fluid WBC ≥26,995 cells/μL, and neutrophil percentage ≥93% diagnosed PJI with high accuracy.Level of EvidenceLevel IV Diagnostic. 相似文献
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Postoperative pseudogout after total knee arthroplasty is rare. If pseudogout attacks are misdiagnosed as periprosthetic sepsis, patients may undergo unnecessary surgical procedures. We report a case of pseudogout in the early postoperative period. The attack ensued shortly after a nonsteroidal antiinflammatory drug was discontinued. The diagnosis was confirmed by aspiration, and the patient improved after readministration of the nonsteroidal antiinflammatory drug. Although rare, pseudogout should be considered in the differential when approaching a suspected infection after total knee arthroplasty. 相似文献
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Parratte S Pagnano MW Coleman-Wood K Kaufman KR Berry DJ 《Clinical orthopaedics and related research》2009,467(1):43-49
Most computer navigation systems used in total hip arthroplasty integrate preoperative pelvic tilt to calculate the anterior
pelvic plane assuming tilt is constant; however, the consistency of pelvic tilt after THA has never been proven. Therefore,
using a modern comprehensive gait analysis before and after arthroplasty we sought to compare (1) dynamic pelvic tilt changes
and (2) pelvic flexion/extension range-of-motion changes. Twenty-one patients who underwent unilateral THA were prospectively
studied. Quantitative pelvic tilt changes (in the sagittal plane) and pelvic range of flexion/extension motion relative to
a laboratory coordinate system were compared using a computerized video motion system. Mean gait pelvic tilt was 13.9o ± 4.8o
(range, 1.73o–23.1o) preoperatively, 12.5o ± 4.5o (range, 1.4o–18.7o) 2 months postoperatively, and 10.5° ± 5.5o (range, –2.36o–19.2o)
12 months postoperatively. A significant proportion (31%) of patients had more than a 5° difference between preoperative and
12-month postoperative measurements and the variability was spread over 20°. Significant dynamic changes in pelvic tilt occurred
after THA. While navigation clearly improves the anatomical position of the component during THA, the functional position
of the component will not always be improved because of the significant change between preoperative and postoperative pelvic
tilt.
Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest,
patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.
Each author certifies that his or her institution has approved the human protocol for this investigation and that all investigations
were conducted in conformity with ethical principles of research, and that informed consent for participation in the study
was obtained. 相似文献
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Hussein Darwiche Wael K. Barsoum Alison Klika Viktor E. Krebs Robert Molloy 《Clinical orthopaedics and related research》2010,468(9):2392-2396
Background
Infection is a devastating complication of total hip arthroplasty (THA). Unavoidable reoperation during the acute recovery phase of hip arthroplasty has the potential for an increased infection rate but the risk is not well established nor is the fate of these infected hips. 相似文献7.
Skeletal muscle trauma and acute coronary occlusion increase the values of aminotransferases, which might render the diagnosis of myocardial infarction in connection with major orthopaedic surgery more difficult. To find clinically useful distinctions, the postoperative course of serum aminotransferases (ASAT, ALAT, LD, GT and ALP) was recorded for the first 3 weeks following total hip arthroplasty and compared with the values found in patients with acute myocardial infarction. The level of ASAT increased during the first days following surgery. The highest recorded value of ASAT during the first 4 days was found to be lower than corresponding values in patients with myocardial infarction, although an overlap between the groups was seen. However, the LD value did not increase significantly following surgery, in contrast to the findings in patients with myocardial infarction. Later in the postoperative course, values for ALAT, GT and ALP rose as well. Two case reports on myocardial infarction after total hip replacement are included. 相似文献
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Daniel J. Blizzard Colin T. Penrose Charles Z. Sheets Thorsten M. Seyler Michael P. Bolognesi Christopher R. Brown 《The Journal of arthroplasty》2017,32(8):2474-2479
Background
Ankylosing spondylitis (AS) is a chronic autoimmune spondyloarthropathy that primarily affects the axial spine and hips. Progressive disease leads to pronounced spinal kyphosis, positive sagittal balance, and altered biomechanics. The purpose of this study is to determine the complication profile of patients with AS undergoing total hip arthroplasty (THA).Methods
The Medicare sample was searched from 2005 to 2012 yielding 1006 patients with AS who subsequently underwent THA. Risk ratios (RRs) with 95% confidence intervals (CIs) were calculated for 90-day, 2-year, and the final postoperative follow-up for complications including hip dislocation, periprosthetic fracture, wound complication, revision THA, and postoperative infection.Results
Compared to controls, AS patients had an RR of 2.50 (CI, 1.04-5.99) of THA component breakage at 90-days post-operatively and 1.99 (CI, 1.10-3.59) at 2-years. The RR of periprosthetic hip dislocation was elevated at 90 days (1.44; CI, 0.93-2.22) and significantly increased at 2-years (1.67; CI, 1.25-2.23) and overall follow-up (1.49; CI, 1.14-1.93). Similarly, the RR for THA revision was elevated at 90-days (1.46; CI, 0.97-2.18) and significantly increased at 2-years (1.69; CI, 1.33-2.14) and overall follow-up (1.51; CI, 1.23-1.85).Conclusion
Patients with AS are at increased risk for complications after THA. Altered biomechanics from a rigid, kyphotic spine place increased demand on the hip joints. The elevated perioperative and postoperative risks should be discussed preoperatively, and these patients may require increased preoperative medical optimization as well as possible changes in component selection and position to compensate for altered spinopelvic biomechanics. 相似文献11.
目的 探讨人工髋、膝关节置换术后感染保留假体清创治疗的指征及注意事项.方法 回顾性分析自2004~2009年收治的7例髋、膝关节置换术后感染(髋3例,膝4例),经术前诊断、评估,行清创加术后抗生素抗感染的保留假体治疗,分析成功、失败原因.结果 7例中5例保留了假体,随访5~72个月,平均24.8个月,感染均无复发.2例... 相似文献
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BackgroundThe increasing prevalence of obesity has resulted in an increased number of revision total hip arthroplasties (rTHAs) performed in patients with a high body mass index (BMI). The aim of this study is to evaluate whether obesity negatively affects (1) complication rate, (2) reoperation and revision rate, and (3) patient-reported outcome in rTHA.MethodsIn this registry-based study, we prospectively followed 444 rTHAs (cup: n = 265, stem: n = 57, both: n = 122) performed in a specialized high-volume orthopedic center between 2013 and 2015. The number of complications, and reoperation and revision surgery was registered until 5 years postoperatively. Oxford Hip Score (OHS) was evaluated preoperatively, and at 1 and 2 years postoperatively. Patients were categorized based on BMI to nonobese (<30 kg/m2, n = 328), obese (30-35 kg/m2, n = 82), and severe obese (≥35 kg/m2, n = 34).ResultsSevere obese patients, but not obese patients, had higher risks of complications and re-revision than nonobese patients. In particular, the risk of infection following rTHA was higher in severe obese patients (24%) compared to nonobese patients (3%; relative risk, 7.7). Severe obese patients had overall poorer OHS than nonobese patients, but improvement in OHS did not differ between severe obese and nonobese patients. No differences between obese and nonobese groups on OHS were observed.ConclusionIn our study, severe obesity was associated with an increased risk of infection following rTHA. Patients with high BMI should be counseled appropriately before surgery. 相似文献
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《The Journal of arthroplasty》2020,35(9):2619-2623
BackgroundAcetabular fractures often require surgical intervention for fracture fixation and can result in premature osteoarthritis of the hip joint. This study hypothesized that total hip arthroplasty (THA) in patients with a prior acetabular fracture who had undergone open reduction and internal fixation (ORIF) is associated with a higher rate of subsequent periprosthetic joint infection (PJI).MethodsAbout 72 patients with a history of acetabular fracture that required ORIF, undergoing conversion THA between 2000 and 2017 at our institution, were matched based on age, gender, body mass index, Charlson comorbidity index, and date of surgery in a 1:3 ratio with 215 patients receiving primary THA. The mean follow-up for the conversion THA cohort was 2.9 years (range, 1-12.15) and 3.06 years (range, 1-12.96) for the primary THA.ResultsPatients with a previous acetabular fracture, compared with the primary THA patients, had longer operative times, greater operative blood loss, and an increased need for allogeneic blood transfusion (26.4% vs 4.7%). Most notably, PJI rate was significantly higher in acetabular fracture group at 6.9% compared with 0.5% in the control group. Complications, such as aseptic revision, venous thromboembolism, and mortality, were similar between both groups.ConclusionThe present study demonstrates that conversion THA in patients with prior ORIF of acetabular fractures is associated with higher complication rate, in particular PJI, and less optimal outcome compared with patients undergoing primary THA. The latter findings compel us to seek and implement specific strategies that aim to reduce the risk of subsequent PJI in these patients. 相似文献
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Background
Postoperative laboratory testing has been used routinely for patients undergoing total hip arthroplasty (THA). However, with modern-day improvements in perioperative care pathways, it is unclear whether this practice remains justified. The purpose of this study was to assess the utility of routine postoperative laboratory tests in primary THA.Methods
The electronic medical records of 351 patients who underwent primary, unilateral THA between 2015 and 2017 were retrospectively reviewed. The primary outcomes were the rates of acute blood loss anemia requiring transfusion, acute kidney injury (AKI), electrolyte abnormalities, and 90-day emergency department visits or readmissions. Multivariate logistic regression analysis was also performed to identify the risk factors associated with abnormal laboratory values.Results
Seventy-four patients (21%) had abnormal postoperative laboratory results, of which 82.4% were exclusively due to electrolyte (sodium or potassium) abnormalities. Factors associated with electrolyte abnormalities were abnormal baseline electrolyte levels (P < .001 and P = .013 for sodium and potassium, respectively), diabetes (P = .007), and lack of tranexamic acid use (P < .01). The rates of AKI and blood transfusion were 2.0% and 2.3%, respectively. Factors associated with blood transfusion were higher American Society of Anesthesiologists class and intraoperative blood loss ≥250 mL combined with either preoperative anemia or lack of tranexamic acid use. Factors associated with AKI were higher American Society of Anesthesiologists class and diabetes. Laboratory results did not change the standard course of care in 338 of 351 patients (96%). Abnormal laboratory values were not associated with increased length of stay (P = .228) or emergency department visits/readmissions (P = .21).Conclusion
This study provides evidence that routine postoperative laboratory testing is not necessary in modern-day primary, unilateral THA. Instead, the decision to obtain laboratory tests after surgery should be driven by patients’ risk factors. 相似文献15.
R. Allen Butler MD Seth Rosenzweig MD Leann Myers PhD Robert L. Barrack MD 《Clinical orthopaedics and related research》2011,469(2):339-347
Background
Most studies of total hip arthroplasty (THA) focus on the effect of the type of implant on the clinical result. Relatively little data are available on the impact of the patient’s preoperative status and socioeconomic factors on the clinical results following THA. 相似文献16.
Han-Jun Lee Kyoung-Woon Kim Ki Seong Kim Sung Hwa Ryu Yong-Chan Ha 《The Journal of arthroplasty》2013
Primary mycobacterial infections in the musculoskeletal system are rare with a limited number of published case reports. This report describes a case involving a primary musculoskeletal tuberculous abscess. A 62-year-old male patient who had a right total hip arthroplasty performed 8 years earlier, using metal-on-metal articulation presented with a 1-year history of non-tender masses on his right thigh. Initially, it was assumed he had metallosis. Intraoperatively, an incision into the mass was conducted which resulted in draining of a whitish-grey pus like fluid. A diagnosis of tuberculosis was confirmed with both microscopic and histological examination. The patient was treated over a course of six months with an anti-tuberculosis medication regimen following the confirmation of a solitary soft tissue tuberculosis infection. At the 24 month follow-up, the patient was asymptomatic with no relapse of the mass. 相似文献
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Air travel and total joint arthroplasty (TJA) are both risk factors for venous thromboembolism (VTE). Patients are counseled against flying after surgery, however the basis for this recommendation has not been investigated and may be unfounded. A retrospective cohort of 1465 consecutive TJA patients was divided into a study population of 220 patients (15.0%) who flew home at a mean of 2.9 days after surgery (range, 1–10 days) and a control population of 1245 patients (85.0%) who did not fly. We found no differences in the rate of deep vein thrombosis, pulmonary embolism, or overall VTE between the groups, and incidence of all events was low in both groups and comparable with published data. Allowing air travel after TJA appears to be a safe practice. 相似文献
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Danielle Y. Ponzio Lazaros A. Poultsides Anthony Salvatore Yuo-yu Lee Stavros G. Memtsoudis Michael M. Alexiades 《The Journal of arthroplasty》2018,33(5):1421-1425.e1
Background
The direct anterior approach (DAA) offers the potential for less soft tissue insult, improved early recovery, and reduced dislocation rates. However, complications are associated with the DAA, particularly during the learning curve. We compare the DAA learning curve experience with the posterior approach regarding in-hospital complications and revision rate.Methods
We evaluated systemic and local in-hospital complications associated with primary unilateral cementless THAs from January 1, 2010 to December 31, 2012 in 4249 patients through a posterior approach and 289 patients through a DAA. All procedures were performed consecutively by high-volume surgeons who use a single approach in a nonselective manner. The DAA was performed by surgeon transitioning from the posterior approach, thus incorporating the learning curve. Demographics were comparable. Revision procedures were captured through a minimum 4-year follow-up. Analyses compared complication and revision rates.Results
The DAA group demonstrated shorter length of stay, procedure time, lower blood transfusion rate, and increased discharge to home rate. Local and major systemic in-hospital complications were rare and comparable between groups. The minor systemic complication rate was significantly greater for the posterior group (10.9% posterior vs 6.2% DAA, P < .05). Revision rate was significantly greater for the posterior group (2.7% posterior vs 0.7% DAA, P < .032). The incidence of revision for dislocation was 1.5% for the posterior approach vs 0.4% for the DAA.Conclusion
There was an increased rate of in-hospital minor systemic complications and overall revision, predominantly due to instability, after THA by the posterior approach, in comparison with the DAA. 相似文献19.
Robert B. Bartelt Brandon J. Yuan Robert T. Trousdale Rafael J. Sierra 《Clinical orthopaedics and related research》2010,468(9):2346-2356
Background
Groin pain after total hip arthroplasty (THA) or total hip resurfacing arthroplasty can be troubling for patients and surgeons. Potential sources of pain include infection, loosening, metal hypersensitivity, or impingement of bony structures or the iliopsoas tendon. 相似文献20.
Fiachra E. Rowan Biju Benjamin Jurek R. Pietrak Fares S. Haddad 《The Journal of arthroplasty》2018,33(5):1316-1324