氨甲环酸减少初次非骨水泥全髋置换围术期失血有效性及安全性研究

背景：全髋关节置换术是治疗髋关节终末期疾病的有效手段,但其常伴随显著的失血且需要输血,人工合成抗纤溶药氨甲环酸在全髋关节置换术围手术期血液管理中正扮演着越来越重要的角色。目的：探讨术前静脉单剂量使用氨甲环酸减少初次单侧非骨水泥全髋关节置换术围术期失血的有效性及安全性。方法方法：回顾分析2012年9月至2013年3月行初次单侧非骨水泥全髋关节置换术前未使用氨甲环酸患者291例（对照组）和2013年4月至9月术前静脉单剂量使用15 mg/kg氨甲环酸患者220例（氨甲环酸组）的临床资料。比较两组术前及术后第1、3天血红蛋白,血细胞比容,住院时间,失血量,输血及血栓事件发生率。结果：氨甲环酸组围术期平均总失血量和输血率显著低于对照组[（973.30±355.65）ml vs（1275.20±453.75）ml,5.45%vs 20.62%,P〈0.001]。氨甲环酸组和对照组术后肌间静脉血栓发生率分别为5.00%和5.15%（P=0.937）。氨甲环酸组中1例（0.45%）发生深静脉血栓,对照组2例（0.69%）,两组比较差异无统计学意义。无1例出现肺栓塞。术后第1天、第3天氨甲环酸组的血红蛋白及血细胞比容均显著高于对照组（P〈0.001）。结论：术前静脉滴注15 mg/kg氨甲环酸可安全、有效地减少初次单侧非骨水泥全髋关节置换术围术期的失血及输血。     

髋关节翻修术失败原因分析

目的 对髋关节翻修术失败原因以及与失败相关的手术技术、假体材料和患者相关易感因素对于不同失败原因的影响进行分析.方法 回顾性分析1995年11月至2008年6月30例髋关节翻修术失败(26例为初次翻修术失败,4例为再次翻修术失败)患者的临床资料.其中男性18例,女性12例;均为单侧病例.患者初次置换平均年龄49岁(25～68岁),初次翻修平均年龄53岁(27～72岁),平均间隔时间43.8个月(0～156个月).对比分析髋关节翻修术与初次置换的失败原因,同时对初次翻修年龄以及翻修失败时间进行分组,比较各组间相关危险因素的统计学意义.结果 以再次翻修或假体取出作为终止点,30例翻修术失败原因包括:无菌性松动22例(73.3%)、感染性松动4例(13.3%)、假体周围骨折3例(其中1例合并假体柄断裂)(10.0%)以及假体不稳定1例(3.3%).患者行最后一次翻修或假体取出平均年龄58岁(38～77岁),距离上一次翻修平均间隔78.8个月(1～216个月).初次翻修时高龄组(60岁以上,n=12)翻修失败时间显著低于低龄组(60岁以下,n=18)(P<0.01).结论 未能获得翻修假体的有效固定与感染复发是全髋关节翻修术失败的主要原因,关节重建理念的局限与手术技术的缺陷是导致翻修失败的重要因素.     

髋关节表面置换术与大直径股骨头全髋关节置换术短期临床效果的比较

目的探讨髋关节表面置换术与大直径股骨头全髋关节置换术两种手术方法的优势并比较两者的短期疗效。方法从2006年1月至2007年12月，笔者对年轻活跃的髋关节疾病患者进行随机分组，分别对79例患者（85髋）行髋关节表面置换术，同期对128例患者（145髋）进行大直径股骨头初次全髋关节置换术，患者平均年龄54.7岁（39-69岁）；男119例，女111例，术前诊断包括股骨头缺血性坏死（24，29例），发育性髋关节发育不良（26，51例），强直性脊柱炎（9，14例），髋关节骨性关节炎（20，34例）。比较两组患者的手术时间、术中出血量、手术切口长度、输血比例以及术后深静脉血栓、术后脱位和感染的发生率，同时分别评估两组患者Harris髋关节评分。结果两组患者在术中出血量，输血比例，使用的股骨头直径，术后髋关节脱位发生率，下肢深静脉血栓发生率以及术后6个月髋关节活动度方面无显著差异。大直径股骨头全髋关节组患者在手术时间，手术切口长度的比较上优于髋关节表面置换组，差异有显著意义。两组患者Harris评分均较术前有显著改善。结论髋关节表面置换术和大直径股骨头全髋关节置换术在年轻髋关节疾患患者中都能获得满意的近期效果，近期效果的比较中显示大直径股骨头全髋关节置换术在手术时间，手术切口长度上具有优势；而髋关节表面置换术在保留骨量和患者运动功能恢复上具有优势。其远期结果有待于进一步的随访。     

全髋关节置换术后下肢不等长对功能和步态的影响

目的探讨全髋关节置换术后下肢不等长与患者功能和步态的关系。方法2008年6月至2009年6月行初次单侧全髋关节置换术的患者62例（其中男28例,女34例）,平均年龄67岁。术后拍摄骨盆正位x线片,测量出双下肢长度差。术后6个月对患者随访,用Harris髋关节功能评分（HHS）评估患者术后功能及步态分析。结果（1）下肢长度：下肢等长者16例。下肢长度术后患肢延长46例,其中延长1-10mm者28例（下肢延长A组）,平均5．3mm;延长11～20mm者18例（下肢延长B组）,平均15．7mm。（2）髋关节HHS评分：下肢延长A和B组之间HHS评分的差异无统计学意义（t=1．5,P〉0．05）,下肢延长B组HHS评分低于等长组（t=2．6,P〈0．05）;（3）步态分析：在步长、单腿支撑时间以及Footoff方面,下肢延长B组与等长组之间存在统计学差异（t=2．6,t=3．2,t=2．8;P〈0．05）,下肢延长A组和等长组之间无统计学差异（t=1．6,t=1．2,t=1．5;P〉0．05）。结论全髋关节置换术后肢体延长时,髋关节步态参数明显改变。当患肢延长超过10mm后,对髋关节功能和步态有一定影响。     

单侧椎弓根螺钉固定椎体间融合治疗腰椎退行性疾病

目的 探讨单侧椎弓根螺钉固定经椎间孔椎体间融合(transforaminal lumbar interbody fusion,TLIF)联合后外侧融合(posterolateral fusion,PLF)技术治疗腰椎退行性疾病的可行性及有效性.方法 分析2006年12月至2008年8月收治的因患腰椎退行性疾病行腰椎后路融合术并获得随访的患者78例.采用单侧椎弓根螺钉固定TLIF联合PLF技术治疗48例(单侧组),男25例,女23例;年龄31～64岁,平均47.6岁.采用双侧椎弓根螺钉固定TLIF联合PLF技术治疗30例(双侧组),男21例,女9例;年龄26～66岁,平均50.5岁.使用Oswestry功能障碍指数,疼痛视觉模拟评分(visual analogue score,VAS)评估两组患者术后疗效,并比较两组患者手术时间、出血量、融合率和椎间隙塌陷率等指标.结果 两组患者的Oswestry功能障碍指数、腰痛VAS评分、腿痛VAS评分在术前与术后3个月以及术后3个月与术后1年之间比较差异均有统计学意义,在术前与术后1年的评分改善方面差值比较无统计学意义.两组患者手术时间、出血量及住院费用比较差异均有统计学意义,单侧组少于双侧组.两组患者术后住院时间比较差异无统计学意义.单、双侧组融合率分别为91.7%(44/48)和93.3%(28/30).结论 椎间植骨联合单侧椎弓根螺钉固定能提供较好的脊柱即刻稳定性.单侧椎弓根固定TLIF联合PLF技术作为一种治疗腰椎退行性疾病的方法,疗效满意.     

大通道全内镜下椎间减压融合单侧与双侧椎弓根螺钉内固定治疗腰椎退行性疾病的疗效比较

【摘要】 目的：比较大通道全内镜下椎间减压融合联合单侧椎弓根螺钉固定与双侧椎弓根螺钉固定治疗单节段腰椎退行性疾病的疗效。方法：回顾性分析2019年12月~2021年10月在我院行大通道全内镜下椎间减压融合内固定手术治疗的47例单节段腰椎退行性疾病患者的临床资料，其中20例采用单侧椎弓根螺钉固定（单侧固定组），男5例，女15例，年龄39~69岁（54.1±9.6岁）；27例采用双侧椎弓根螺钉固定（双侧固定组），男9例，女18例，年龄40~70岁（57.8±9.4岁）。两组患者的年龄、体重指数（body mass index，BMI）、性别、手术节段、疾病类型、随访时间等一般资料均无统计学差异（P>0.05）。比较两组患者手术时间、术中透视次数、住院费用、住院时间、手术前后的血红蛋白及变化值和并发症发生率；术前及术后3天、3个月、1年采用疼痛视觉模拟评分（visual analog scale，VAS）评价腰腿痛，术前及术后3个月、1年采用Oswestry功能障碍指数（Oswestry disability index，ODI）评价功能障碍情况；术后1年根据CT评价椎间融合情况，通过改良MacNab标准对临床疗效进行评价。结果：所有患者手术顺利，均获得1年及以上随访，双侧固定组手术时间、术中透视次数、住院费用、住院时间均显著性高于单侧固定组（P<0.05）。两组患者术前、术后血红蛋白值及血红蛋白变化值均无统计学差异（P>0.05）。两组患者术后3天、3个月、1年的VAS评分及术后3个月、1年的ODI均较术前明显下降（P<0.05）；两组同时间点VAS评分及ODI比较均无统计学差异（P>0.05）。两组并发症发生率（单侧固定组10.0% vs 双侧固定组11.1%）、术后1年融合率（单侧固定组90.0% vs 双侧固定组92.6%）及改良MacNab优良率（单侧固定组90.0% vs 双侧固定组88.9%）均无统计学差异（P>0.05）。结论：大通道全内镜下椎间减压融合联合单侧椎弓根螺钉固定与双侧椎弓根螺钉固定治疗单节段腰椎退行性疾病均安全有效，与双侧固定相比，单侧固定术中透视次数、手术时间、住院费用、住院时间更具有优势。     

Gamma3钉与DHS治疗股骨粗隆间骨折的临床比较

目的 比较和分析Gamma 3钉与动力髋螺钉（dynamic hip screw,DHS）治疗股骨粗隆间骨折的临床效果.方法 回顾性分析2009年1月至2012年1月122 例股骨粗隆间骨折患者病例资料,其中实施Gamma 3钉内固定治疗者60 例（男16 例,女44 例;平均年龄71.8 岁）,采用DHS内固定治疗者62 例（男17 例,女45 例;平均年龄72.1 岁）,两组患者年龄、性别、受伤原因、骨折类型、并发症、围手术期处理、术后治疗等基本情况无明显差异,比较和分析两组患者手术时间、术中失血量、输血量、住院时间、术后并发症、骨折愈合时间及关节功能恢复状况.结果 所有病例均随访6～25个月,平均12.5个月;手术时间、住院时间DHS组显著长于Gamma 3钉组（P＜0.01）;术后并发症DHS组显著高于Gamma 3钉组（P＜0.05）;术后骨折愈合时间DHS显著短于Gamma 3钉组（P＜0.05）,术后髋关节功能良好率两组疗效差异无统计学意义（P＞0.05）.结论 两种手术方法各有优缺点,术前应正确评估患者生理和心理状态及骨折类型,合理地制定手术策略.     

改进型Tri—lock骨保留假体的短期临床应用研究

目的 评价改进型Tri lock骨保留假体在初次全髋关节置换术中的应用,分析这种改进型假体的稳定性及临床效果.方法 选取2011年3月到2012年3月本组接受初次全髋关节置换术治疗的患者36例（37髋）,男5例,女31例;年龄48～71岁,平均年龄54岁.新鲜股骨颈骨折5例、5髋.股骨头坏死Ⅲ期6例、6髋,Ⅳ期7例、7髋.DDH CroweⅠ型继发髋关节骨关节炎5例（6髋）,Ⅱ型继发髋关节骨关节炎2例（2髋）.原发性髋关节骨关节炎11例（11髋）.髋臼假体全部采用生物型假体,内衬采用陶瓷内衬的27髋,采用金属内衬的10髋,股骨头全部采用陶瓷头.手术均采用髋关节后外侧切口,术后3、6、12个月及以后每年随访一次,采用Harris髋关节评分和骨性关节炎指数可视化量表（WOMAC）,对患者手术前后关节功能进行评估.结果 36例患者（37髋）全部获得随访,随访时间范围15～27个月,平均随访时间 24.8个月.Harris髋关节评分从术前平均（20.33±10.40）分提高到末次随访时的（93.96±4.45）分,手术前后差异有统计学意义（t=28.37,P〈0.01）.骨关节炎指数（WOMAC）评分改善显著,总分由术前（77.41± 13.07）分降至末次随访时的（11.53±4.56）分,手术前后差异有统计学意义（t=21.37,P〈0.01）.随访期间未发现假体松动,脱位及感染.结论 由于假体本身设计特点,更加符合身高较矮、骨骼较小的亚洲人,其次可以保留更多的骨量,假体初始稳定性好,陶瓷-陶瓷界面或陶瓷-金属界面磨损率低,近期疗效好,并发症少,易于二次翻修.     

直接前方入路行髋关节翻修术的临床疗效研究

目的：探讨直接前方入路（DAA）行髋关节翻修术的临床安全性、临床有效性及手术要点。方法：回顾分析2018年1月至2021年1月因各种原因需要接受髋关节翻修术且手术入路为DAA的15例患者的临床资料,其中男3例,女12例,平均年龄（66.8±12.0）岁。初次髋关节置换失败的主要原因包括假体松动8例,磨损2例,骨溶解3例,假体周围骨折2例。记录患者手术时间、住院时长、术中出血量、肌酸激酶（CK）水平变化及是否发生并发症等,术后随访复查髋关节正侧位X线片等评估假体情况。末次随访评估患者的西安大略麦克马斯特大学骨关节炎指数（WOMAC）、Harris髋关节功能评分、简明健康调查问卷（SF-12）及疼痛视觉模拟评分（VAS）。结果：15例患者平均随访时间为（26.5±9.3）个月,其中9例为单纯的髋臼侧翻修,6例为髋臼侧及股骨侧翻修。手术时间平均为（148.0±56.7）min,术中平均出血量（531±130）ml,术后平均住院时长（5.2±3.8）d,术后第3天CK较术前平均增加（535.4±238.5）U/L。术后患者双下肢不等长均在5 mm以内,翻修术后臼杯前倾角和外展角分别为20.4°...     

肥胖患者膝关节表面置换术后的早期康复

目的探讨肥胖患者初次膝关节置换术后早期康复的方法。方法自2009年1月至2012年6月共完成肥胖患者初次膝关节置换42例42膝,男8例,女34例;年龄60～78岁,平均65岁,身体质量指数（BMI）33—52,平均46。术后早期进行持续被动关节运动增加关节活动度（ROM）和进行股四头肌及胭绳肌肌力的强化训练,延长住院时间至术后14d。分别以术前2d、术后2d、1、2、4、8、12、24周作为观察点,使用VAS疼痛评分、WOMAC评分和ROM对膝关节功能及疼痛程度进行评价。结果术后VAS疼痛评分、WOMAC评分低于术前,术后ROM高于术前,差异均有统计学意义。所有指标在术后4周以后均有逐步改善,但差异没有统计学意义。结论肥胖患者膝关节置换术后早期行功能锻炼及适当延长住院时间可以提高膝关节功能。     

24 hours stay after hip replacement

Background and purpose — The length of stay after total hip arthroplasty has been reduced to 2–4 days after implementing fast-track surgery. We investigated whether a new time-based patient-centered primary direct anterior approach (DAA) total hip arthroplasty (THA) treatment protocol in a specialized clinic, with a planned length of stay of about 24?hours, could be achieved in all patients or only in a selected group of patients.

Patients and methods — We analyzed prospectively collected data in a cohort of 378 consecutive patients who underwent a primary direct anterior THA as a patient-centered time-based procedure between March 1, 2012 and December 31, 2015. Patients with complicated medical comorbidity and those over the age of 85 were excluded from the study. The average length of stay was recorded and all complications, re-admissions, and reoperations were registered and analyzed. The primary outcome measures were length of stay and complication rate, at discharge and 90 days postoperatively.

Results — The average length of stay for all patients was 26?hours. All patients were discharged from the clinic on the day after the operation and were able to continue their recovery at home or in a rehabilitation facility. The overall complication rate within 3 months of surgery was 6%. The 3-month re-admission rate and the 3-month reoperation rate were both 2%.

Interpretation — Performing a time-based, patient-centered fast-track program for DAA total hip arthroplasty can result in a standardized length of stay of about 24?hours and a high level of patient satisfaction with few complications, re-admissions, and reoperations.     

The utility of bladder catheterization in total hip arthroplasty

The use of a urinary bladder catheter in patients having a total hip arthroplasty is controversial. Universal insertion of an indwelling catheter before a total hip arthroplasty, and insertion of a catheter postoperatively as necessary, are accepted variations of care. From 1993 to 1999, 719 patients having primary, unilateral total hip arthroplasties were randomized by surgeons into two groups: a group of patients who had universal preoperative insertion of an indwelling bladder catheter (340 patients) and an observation group who had catheterization as needed (379 patients). Catheterization was required for 295 of these 379 patients (77.8%). Patients were followed up using a total hip arthroplasty database, which recorded all complications. Six patients (1.8%) in the universal catheter insertion group had a urinary tract infection develop. Nine patients (2.4%) in the catheter as necessary group had a urinary tract infection develop. There was no significant difference in incidence of urinary tract infections between the two groups. Female gender and increasing age were associated with a higher incidence of urinary tract infection in both groups. The average length of stay in the hospital for the universal catheter group was 4.8 days, and the average length of stay for the catheter as necessary group was 4.5 days. There was no significant difference in length of stay in the hospital between the two groups. The universal catheter group had an average 590 dollars higher hospital cost for their total hip arthroplasties, which was significant. Routine preoperative bladder catheterization may not be warranted in patients having total hip arthroplasties. Postoperative catheterization as necessary may be more cost effective.     

Single-stage bilateral total hip arthroplasty

The number of single-stage bilateral total hip arthroplasties done each year is increasing. The risk of postoperative complications in medically stable patients is acceptable; complications are approximately 1.3 times more frequent than with unilateral total hip arthroplasty. Although there are no absolute indications for a single-stage bilateral total hip arthroplasty, the procedure is usually contraindicated in patients with such comorbidities as heart disease, pulmonary insufficiency, or diabetes, and it is absolutely contraindicated in patients with a documented patent ductus arteriosus or septal defect. The primary postoperative concern is that the cardiopulmonary insult associated with two surgical wounds and surgeries can lead to an increase in thromboembolic events. The cost for single-stage bilateral total arthroplasty is less than that for a two-stage bilateral total hip arthroplasty, with savings predominantly due to reduced length of acute hospital stay. However, the decision to undergo single-stage bilateral total hip arthroplasty is one that must be made in concert with the patient.     

Cost comparison between bilateral simultaneous,staged, and unilateral total joint arthroplasty

A hospital-based computer system was used to compare the inpatient costs of performing bilateral simultaneous sequential, staged, and unilateral total hip and knee arthroplasties. Bilateral simultaneous sequential total knee arthroplasty was 36% less costly than 2 unilateral total knee arthroplasties. Bilateral simultaneous sequential total hip arthroplasty saved 25% over the costs of performing 2 unilateral hip arthroplasties. Prosthetic costs range between 28% and 43% of the total costs of hospitalization. There was a significant correlation between hospital length of stay, morbidity, and total costs, but no correlation with patient age and sex except in the unilateral knee patients. Bilateral simultaneous sequential joint arthroplasty can save more than $10,000 for each total knee patient and more than $8,000 for each total hip patient.     

Are clinical and patient assessed outcomes affected by reducing length of hospital stay for total hip arthroplasty?

This prospective observational study investigated the relationship between the length of hospital stay (LOS) and outcomes at 3 months for primary total hip arthroplasty for osteoarthritis. Mean length of postoperative stay was 9.5 +/- 2.8 days. Predictors of LOS were patient's age, sex, and number of comorbidities; preoperative Charnley scores and Nottingham Health Profile measures; complications; and hospital in which surgery took place. LOS was found to have a small negative correlation with outcome. The dominant association with improved outcome was the severity of the patients' impairment preoperatively. These data suggest that in situations in which adequate rehabilitation and support are available after discharge, a marginal reduction in postoperative LOS--from the average of 10.3 days observed at 1 hospital to the average of 8 days observed at another--would not adversely affect the short-term outcome.     

Two-Incision Minimally Invasive vs Standard Total Hip Arthroplasty: Comparison of Component Position and Hospital Costs

Forty-nine patients undergoing 2-incision total hip arthroplasty were matched by age, gender, body mass index, and comorbidity to patients undergoing a standard lateral Hardinge approach. Hospital costs and charges were compared along with length of stay, component position, and complication rates. Component position and complication rates were identical for the 2 groups. However, hospital costs and charges were significantly lower for the 2-incision group, as was length of stay.     

低蛋白血症延长髋膝关节置换患者住院日

目的 探讨术前低蛋白血症和初次髋膝关节置换术住院时长的相关性.方法 回顾性分析2017年8月至2019年1月在南京鼓楼医院运动医学与成人重建外科行初次人工关节置换术的患者资料,排除掉资料不全、围手术期对并发症进行过针对治疗、一期行双侧关节置换、行翻修手术、血友病性关节炎等病人,共纳入男253例,女640例,年龄范围19...     

Total Hip Arthroplasty Revision Surgery: Impact of Morbidity on Perioperative Outcomes

BackgroundPrimary and revision total hip arthroplasty (THA) is increasingly performed in patients with high comorbidity burden. Its predominantly negative effects on outcomes are well understood in primary THA; however, the effects of morbidity on revision THA are unknown. Since revision procedures account for about 10% of the total surgical volume, we set out to investigate the effects of physical health status on perioperative outcomes in this setting.MethodsWe queried our prospectively collected institutional database for patients who underwent revision THA at our institution (Orthopedic University Hospital Friedrichsheim, Frankfurt) between 2007 and 2011. Patients were classified according to American Society of Anesthesiologists (ASA) category and number of comorbidities. Subsequently, their impact on perioperative parameters was analyzed.ResultsOur database revealed 294 cases of revision THA during the study period. Patients preoperatively classified as ASA 3 and 4 showed significantly higher rates of intraoperative and postoperative complications, transfusions, prolonged intensive care unit (ICU) stay, and total length of stay (LOS) compared to patients classified as ASA 1 and 2. Similarly, patients with >3 comorbidities presented with significantly elevated postoperative complications, ICU stay, and LOS. Particularly, preoperative cardiac diseases were associated with increased blood loss, transfusions, duration of surgery, postoperative complications, ICU stay, LOS, and re-revisions.ConclusionPoor physical health condition is associated with negative perioperative outcomes in revision THA. Especially cardiac comorbidities are linked to unfavorable outcomes, which have important implications for assessment of perioperative risk.     

Provider volumes and early outcomes of primary total joint replacement in Ontario

Background

A relation between provider volume and outcome of total joint replacement (TJR) has not been demonstrated in Canada. Given the recent increase in TJR, changing patient characteristics and small sizes of previous Ontario studies, we reassessed whether adverse outcomes of TJR are related to hospital and surgeon procedure volumes.

Methods

We included all Ontarians aged 20 years and older who underwent a unilateral elective primary total hip replacement (THR) or total knee replacement (TKR) between April 2000 and March 2004. The main data sources were hospital discharge abstracts and physician billings. We defined provider volume as the average annual number of primary and revision procedures performed by hospitals and surgeons during the study period. We assessed the association between procedure volumes and acute length of hospital stay (ALOS) and between volume and rate of surgical complications during the index admission; death within 90 days of operation; readmission for amputation, fusion or excision within 1 year; and revision arthroplasty within 1 year. We adjusted for age, sex, comorbidity, arthritis type, teaching hospital status and discharge disposition. The analyses of hospital volume were adjusted for surgeon volume and vice versa.

Results

We included 20 290 patients who received THR and 27 217 who received TKR. Patient age, sex and comorbidity were significant predictors of complications and mortality. There were no associations between provider volume and mortality. Findings for other outcomes were mixed. Surgeon procedure volume was related to rates of revision THR but not to rates of revision TKR. Shorter ALOS was associated with male sex, younger age, fewer comorbidities, discharge to a rehabilitation unit or facility and greater surgeon volume.

Conclusion

Patient characteristics were significant predictors of complications, ALOS and mortality after primary TJR. Evidence for a relation between provider volume and outcome was limited and inconsistent.     

Acute colonic pseudo-obstruction after elective total joint arthroplasty

A retrospective review of 31 patients who developed acute colonic pseudo-obstruction (ACPO) after total joint arthroplasty was undertaken to determine predisposing factors related to, and outcomes following, therapeutic intervention. Comparison with all patients who underwent total joint arthroplasty revealed an overall 1.2% incidence of ACPO. There was a higher incidence of ACPO in patients undergoing sequential bilateral total knee arthroplasty (3.4%) compared with unilateral total knee arthroplasty (0.3%) and a higher incidence in patients undergoing revision total hip arthroplasty (5.6%) compared with primary total hip arthroplasty (1.4%). Additional risk factors for developing ACPO included slow postoperative mobilization and male gender. No association was found with respect to body mass index, age, comorbidity, anesthetic type, international normalized ratio level, or postoperative analgesia. There were no deaths, and 2 patients required operative intervention. The remaining cases of ACPO resolved with nonsurgical treatment. In all cases, there was a prolonged length of hospitalization (mean, 13.2 days) compared with all other arthroplasties performed at our institution (mean, 7.5 days).