Journal articles on the topic 'Hip joint Surgery Risk factors'
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Slobodskoy, A. B., E. Yu Osintsev, A. G. Lezhnev, I. V. Voronin, I. S. Badak, and A. G. Dunaev. "Risk Factors for Periprosthetic Infection after Large Joint Arthroplasty." Vestnik travmatologii i ortopedii imeni N.N. Priorova, no. 2 (June 30, 2015): 13–18. http://dx.doi.org/10.32414/0869-8678-2015-2-13-18.
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Risk factors for the development of purulent complications after large joints arthroplasty were studied by the results of 3641 operations (3210 patients). Hip, knee, shoulder and elbow arthroplasty was performed in 2523, 881, 105 and 132 patients, respectively. Hip and knee revision replacements were performed in 221 cases and in 492 cases surgical interventions were performed for dysplastic coxarthrosis, congenital and acquired deformities, under conditions of bone tissue deficit and other complicated cases. Three hundred fifty one patients were operated on due to acute injury. Periprosthetic infection was diagnosed in 58 cases (1.59%). It was stated that risk factors for periprosthetic infection development included severe concomitant pathology (diabetes mellitus,operations somatic diseases, degree of their severity and duration, HIV infection and other conditions), surgical interventions for dysplastic coxarthrosis and complex total hip replacement. In those cases the risk of complications increased by 1.5-3.5 times. Pyo-inflammatory process in the area of hip joint in history as well as every repeated surgery on the hip increased therisk of postoperative complications significantly. No differences in complication rate depending on the type of fixation and implant manufacturers were noted.
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Slobodskoy, A. B., E. Yu Osintsev, A. G. Lezhnev, I. V. Voronin, I. S. Badak, and A. G. Dunaev. "Risk Factors for Periprosthetic Infection after Large Joint Arthroplasty." N.N. Priorov Journal of Traumatology and Orthopedics 22, no. 2 (June 15, 2015): 13–18. http://dx.doi.org/10.17816/vto201522213-18.
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Risk factors for the development of purulent complications after large joints arthroplasty were studied by the results of 3641 operations (3210 patients). Hip, knee, shoulder and elbow arthroplasty was performed in 2523, 881, 105 and 132 patients, respectively. Hip and knee revision replacements were performed in 221 cases and in 492 cases surgical interventions were performed for dysplastic coxarthrosis, congenital and acquired deformities, under conditions of bone tissue deficit and other complicated cases. Three hundred fifty one patients were operated on due to acute injury. Periprosthetic infection was diagnosed in 58 cases (1.59%). It was stated that risk factors for periprosthetic infection development included severe concomitant pathology (diabetes mellitus,operations somatic diseases, degree of their severity and duration, HIV infection and other conditions), surgical interventions for dysplastic coxarthrosis and complex total hip replacement. In those cases the risk of complications increased by 1.5-3.5 times. Pyo-inflammatory process in the area of hip joint in history as well as every repeated surgery on the hip increased therisk of postoperative complications significantly. No differences in complication rate depending on the type of fixation and implant manufacturers were noted.
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Guo, Heng, Chi Xu, and Jiying Chen. "Risk factors for periprosthetic joint infection after primary artificial hip and knee joint replacements." Journal of Infection in Developing Countries 14, no. 06 (June 30, 2020): 565–71. http://dx.doi.org/10.3855/jidc.11013.
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Introduction: We aimed to explore the risk factors for periprosthetic joint infection (PJI) after primary artificial hip and knee joint replacements by performing a case-control study.
Methodology: The clinical data of patients receiving primary hip and knee joint replacements were retrospectively analyzed. The case group included 96 patients who suffered from PJI, comprising 42 cases of hip joint replacement and 54 cases of knee joint replacement. Another 192 patients who received joint replacement at the ratio of 1:2 in the same period and did not suffer from PJI were selected as the control group. Differences between the two groups were compared in regard to etiology, pathogen, blood type, urine culture, body mass index (BMI), surgical time, intraoperative blood loss, postoperative 1st day and total drainage volumes, length of hospitalization stay, and history of surgery at the affected sites.
Results: Gram-positive bacteria were the main pathogens for PJI. The most common infection after hip joint replacement was caused by Staphylococcus epidermidis, which accounted for 38.10%, while Staphylococcus aureus was mainly responsible for the infection of knee joint (40.74%). High BMI, long surgical time, large postoperative drainage volume, long hospitalization stay, history of surgery at incisions, previous use of immunosuppressants, preoperative hypoproteinemia and superficial infection were independent risk factors (p < 0.05).
Conclusions: PJI after primary replacement was mainly caused by gram-positive bacteria, and patients with high BMI, long surgical time, large postoperative drainage volume, long hospitalization stay, history of surgery at incisions, previous use of immunosuppressants, preoperative hypoproteinemia and superficial infection were more vulnerable.
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Braginа, S. V., V. P. Moskalev, A. L. Petrushin, and P. A. Berezin. "Perioperative prognosis of infectious complications after total hip and knee arthroplasties. Part II (literature review)." Genij Ortopedii 28, no. 4 (August 2022): 608–18. http://dx.doi.org/10.18019/1028-4427-2022-28-4-608-618.
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Introduction Risk factors in the perioperative period are important for reduction of the infection rate following total hip and knee arthroplasty. The objective of the review was to systematize information on potentially modifiable risk factors for infectious complications following total hip and knee arthroplasty and the possibilities to control them. Material and methods For a comprehensive search, PubMed, eLIBRARY, Scopus, Dimensions were used. The search depth was 30 years. Results The review reports potentially modifiable risk factors and the possibility to control them in the perioperative period. Patients undergoing total joint replacements often suffer comorbid conditions that must be addressed preoperatively and postoperatively. Comorbidities can be associated with such joint pathologies as oligo-, polyosteoarthrosis, arthroplasty of other joints, septic arthritis or with a history of periprosthetic joint infection. Somatic disorders can be associated with abnormal laboratory findings. All these risk factors cannot be eliminated completely and are detrimental for hip and knee arthroplasty. Discussion The current level of information on the risks of infectious complications following total hip and knee arthroplasty may be insufficient to reduce the spread of an infectious agent. There is controversy regarding some predictors of surgical site infection and periprosthetic joint infection. There may be equivocal cause-effect relationships between the patient's potentially unfavorable features and the adverse outcome, which requires further in-depth study of this problem.
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Stołtny, Tomasz, Jarosław Pasek, Dominika Rokicka, Marta Wróbel, Michał Dobrakowski, Paweł Kamiński, Rafał Domagalski, Szymon Czech, Krzysztof Strojek, and Bogdan Koczy. "Are there really specific risk factors for heterotopic ossifications? A case report of ‘non-risk factor’ after total hip replacement." Journal of International Medical Research 50, no. 6 (June 2022): 030006052210952. http://dx.doi.org/10.1177/03000605221095225.
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Femoral neck fractures are one of the most common fractures in the elderly population. Due to frequent complications of the fixation of these fractures, patients are more and more often eligible for hip replacement surgery. One of the most frequently mentioned postoperative complication is the formation of heterotopic ossification. This case report describes as a 70-year-old male patient that presented with an old hip fracture accompanied by a mild craniocerebral trauma. The patient underwent total cementless hip arthroplasty followed by rehabilitation. At 8 months after surgery, the patient was diagnosed with Brooker IV° heterotopic ossification in the area of the operated hip joint. Due to the persistent pain and complete loss of mobility in the operated joint, computed tomography imaging was performed and the patient was recommended for a revision surgery. The procedure was performed 14 months after the original surgical treatment, resulting in a significant improvement in the range of motion and reduction of pain.
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Venher, Ihor, Sviatoslav Kostiv, and Dymytrii Khvalyboha. "Risk factors for venous thrombosis in patients with endoprosthetics of hip joints." Journal of Education, Health and Sport 11, no. 9 (September 30, 2021): 875–85. http://dx.doi.org/10.12775/jehs.2021.11.09.102.
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Background. Important part of orthopaedic surgery is endoprosthetics of hip joints, which eliminates pain syndrome, restores the amplitude of movements and the support ability of the lower limb. But there is a number of complications; venous thromboembolism among them occupies a leading place.
Material and methods. 219 patients with a mean age of 64.7 ± 3.8 years were operated. In 137 (62.1%) observations, total cement hip replacement was performed for osteoarthritis. 82 (37.4%) patients received total and unipolar cement hip replacement for cervical femoral neck fractures.
Results. Clinical manifestations of non-specific connective tissue dysplasia were detected in 83 (37.9%) patients, which were confirmed by the laboratory determination of the level of general, bound and free oxyproline. In the postoperative period, the thrombotic process in the venous system of the inferior vena cava was diagnosed in 23 (10.5%) observations. Operative intervention on the hip joint in patients with nonspecific dysplasia of connective tissue in 11 (13.3%) cases was complicated by the development of venous thrombosis. In patients without non-specific connective tissue dysplasia, postoperative thrombosis in the system of the inferior vena cava was diagnosed in 12 (8.8%) observations.
Conclusions. Patients with osteoarthrosis of the hip joint and the femoral neck fracture accompanied by the non-specific dysplasia of the connective tissue are characterized by expressed levels of endothelial dysfunction and increased activity of the blood-coagulation system.
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GANDHI, RAJIV, FAHAD RAZAK, J. RODERICK DAVEY, and NIZAR N. MAHOMED. "Metabolic Syndrome and the Functional Outcomes of Hip and Knee Arthroplasty." Journal of Rheumatology 37, no. 9 (July 15, 2010): 1917–22. http://dx.doi.org/10.3899/jrheum.091242.
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Objective.Patients with an elevated systemic inflammatory state are known to report greater pain with knee osteoarthritis (OA). We investigated the influence of risk factors of metabolic syndrome (MetS) on patient function before and after hip and knee replacement surgery.Methods.A total of 677 consecutive patients with primary knee replacement and 547 consecutive patients with primary hip replacement with at least one MetS risk factor were reviewed from our joint registry. Demographic variables of age, sex, and comorbidity were retrieved. MetS risk factors were defined as body mass index (BMI) > 30 kg/m2, diabetes, hypertension, and hypercholesterolemia. Baseline and 1-year Western Ontario McMaster University Osteoarthritis Index (WOMAC) scores were compared across patients by number of MetS risk factors, ranging from 1 to 4. Linear regression modeling was used to evaluate the effects of the MetS risk groups and the individual metabolic abnormalities on predicting baseline and 1-year WOMAC scores. Knee and hip patients were reviewed separately.Results.The knee and hip patients showed a significant difference in sex distribution, BMI, and mean comorbidity across risk groups (p < 0.05). Unadjusted analysis showed that baseline and 1-year WOMAC scores, for both knee and hip patients, increased significantly with increasing number of MetS risk factors (p < 0.05). The linear regression model with the individual metabolic abnormalities was found to be more predictive of outcome than one with the number of MetS risk factors. Hypertension and obesity were the metabolic factors most predictive of a poorer outcome following hip surgery as compared to just obesity for knee patients.Conclusion.Patient function following joint replacement surgery, particularly hip surgery, is negatively affected by metabolic abnormalities perhaps secondary to the systemic proinflammatory state. This knowledge should be used when counseling patients prior to surgery.
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Bourget-Murray, Jonathan, Isabel Horton, Jared Morris, Antoine Bureau, Simon Garceau, Hesham Abdelbary, and George Grammatopoulos. "Periprosthetic joint infection following hip hemiarthroplasty." Bone & Joint Open 3, no. 12 (December 1, 2022): 924–32. http://dx.doi.org/10.1302/2633-1462.312.bjo-2022-0138.r1.
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Aims The aims of this study were to determine the incidence and factors for developing periprosthetic joint infection (PJI) following hemiarthroplasty (HA) for hip fracture, and to evaluate treatment outcome and identify factors associated with treatment outcome. Methods A retrospective review was performed of consecutive patients treated for HA PJI at a tertiary referral centre with a mean 4.5 years’ follow-up (1.6 weeks to 12.9 years). Surgeries performed included debridement, antibiotics, and implant retention (DAIR) and single-stage revision. The effect of different factors on developing infection and treatment outcome was determined. Results A total of 1,984 HAs were performed during the study period, and 44 sustained a PJI (2.2%). Multiple logistic regression analysis revealed that a higher CCI score (odds ratio (OR) 1.56 (95% confidence interval (CI) 1.117 to 2.187); p = 0.003), peripheral vascular disease (OR 11.34 (95% CI 1.897 to 67.810); p = 0.008), cerebrovascular disease (OR 65.32 (95% CI 22.783 to 187.278); p < 0.001), diabetes (OR 4.82 (95% CI 1.903 to 12.218); p < 0.001), moderate-to-severe renal disease (OR 5.84 (95% CI 1.116 to 30.589); p = 0.037), cancer without metastasis (OR 6.42 (95% CI 1.643 to 25.006); p = 0.007), and metastatic solid tumour (OR 15.64 (95% CI 1.499 to 163.087); p = 0.022) were associated with increasing PJI risk. Upon final follow-up, 17 patients (38.6%) failed initial treatment and required further surgery for HA PJI. One-year mortality was 22.7%. Factors associated with treatment outcome included lower preoperative Hgb level (97.9 g/l (SD 11.4) vs 107.0 g/l (SD 16.1); p = 0.009), elevated CRP level (99.1 mg/l (SD 63.4) vs 56.6 mg/l (SD 47.1); p = 0.030), and type of surgery. There was lower chance of success with DAIR (42.3%) compared to revision HA (66.7%) or revision with conversion to total hip arthroplasty (100%). Early-onset PJI (≤ six weeks) was associated with a higher likelihood of treatment failure (OR 3.5 (95% CI 1.2 to 10.6); p = 0.007) along with patients treated by a non-arthroplasty surgeon (OR 2.5 (95% CI 1.2 to 5.3); p = 0.014). Conclusion HA PJI initially treated with DAIR is associated with poor chances of success and its value is limited. We strongly recommend consideration of a single-stage revision arthroplasty with cemented components. Cite this article: Bone Jt Open 2022;3(12):924–932.
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Wu, Meng-Huang, Christopher Wu, Jiann-Her Lin, Li-Ying Chen, Ching-Yu Lee, Tsung-Jen Huang, Yi-Chen Hsieh, and Li-Nien Chien. "Risk Factors for Spine Reoperation and Joint Replacement Surgeries after Short-Segment Lumbar Spinal Surgeries for Lumbar Degenerative Disc Disease: A Population-Based Cohort Study." Journal of Clinical Medicine 10, no. 21 (October 31, 2021): 5138. http://dx.doi.org/10.3390/jcm10215138.
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Background: Short-segment lumbar spinal surgery is the most performed procedure for treatment of degenerative disc disease. However, population-based data regarding reoperation and joint replacement surgeries after short-segment lumbar spinal surgery is limited. Methods: The study was a retrospective cohort design using the Taiwan National Health Insurance Research Database for data collection. Patients selected were diagnosed with lumbar degenerative disc disease and undergone lumbar discectomy surgery between 2002 and 2013. The Kaplan–Meier method was used to estimate the incidence of 1-year spine reoperation and joint replacement surgeries, and the Cox proportional hazard regression was used to examine risk factors associated with the outcomes of interest. Results: A total of 90,105 patients were included. Incidences of 1-year spine reoperation and joint replacement surgeries for the hip and knee were 0.27, 0.04, and 0.04 per 100 people/month. Compared to fusion with the fixation group, fusion without fixation and the non-fusion group had higher risks of spine reoperation. Risk factors associated with spine reoperation included fusion without fixation, non-fusion surgery, age ≥ 45 years old, male gender, diabetes, a Charlson Comorbidity Index = 0, lowest social economic status, and steroid use history. Spine surgeries were not risk factors for joint replacement surgeries. Conclusions: Non-fusion surgery and spinal fusion without fixation had higher risks for spine reoperation. Spine surgeries did not increase the risk for joint replacement surgeries.
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Naal, Florian D., Aileen Müller, Viju D. Varghese, Vanessa Wellauer, Franco M. Impellizzeri, and Michael Leunig. "Outcome of Hip Impingement Surgery: Does Generalized Joint Hypermobility Matter?" American Journal of Sports Medicine 45, no. 6 (January 31, 2017): 1309–14. http://dx.doi.org/10.1177/0363546516688636.
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Background: Generalized joint hypermobility (JH) might negatively influence the results of surgical femoroacetabular impingement (FAI) treatment, as JH has been linked to musculoskeletal pain and injury incidence in athletes. JH may also be associated with worse outcomes of FAI surgery in thin females. Purpose: To (1) determine the results of FAI surgery at a minimum 2-year follow-up by means of patient-reported outcome measures (PROMs) and failure rates, (2) assess the prevalence of JH in FAI patients and its effect on outcomes, and (3) identify other risk factors associated with treatment failure. Study Design: Cohort study; Level of evidence, 3. Methods: We included 232 consecutive patients (118 females; mean age, 36 years) with 244 hips surgically treated for symptomatic FAI between 2010 and 2012. All patients completed different PROMs preoperatively and at a mean follow-up of 3.7 years. Satisfaction questions were used to define subjective failure (answering any of the 2 subjective questions with dissatisfied/ very dissatisfied and/or didn’t help/ made things worse). Conversion to total hip replacement (THR) was defined as objective failure. JH was assessed using the Beighton score. Results: All PROM values significantly ( P < .001) improved from preoperative measurement to follow-up (Oxford Hip Score: 33.8 to 42.4; University of California at Los Angeles Activity Scale: 6.3 to 7.3; EuroQol−5 Dimension Index: 0.58 to 0.80). Overall, 34% of patients scored ≥4 on the Beighton score, and 18% scored ≥6, indicating generalized JH. Eleven hips (4.7%) objectively failed and were converted to THR. Twenty-four patients (10.3%) were considered as subjective failures. No predictive risk factors were identified for subjective failure. Tönnis grade significantly ( P < .001) predicted objective failure (odds ratio, 13; 95% CI, 4-45). There was a weak inverse association ( r = −0.16 to −0.30) between Beighton scores and preoperative PROM values. There were no significant associations between Beighton scores and postoperative PROM values or subjective failure rates, but patients who objectively failed had lower Beighton scores than did nonfailures (1.6 vs 2.6; P = .049). Conclusion: FAI surgery yielded favorable outcomes at short- to midterm follow-up. JH as assessed by the Beighton score was not consistently associated with subjective and objective results. Joint degeneration was the most important risk factor for conversion to THR. Although statistical significance was not reached, female patients with no joint degeneration, only mild FAI deformity, and higher Oxford scores at the time of surgery seemed to be at increased risk for subjective dissatisfaction.
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Trela-Larsen, Lea, Gard Kroken, Christoffer Bartz-Johannessen, Adrian Sayers, Parham Aram, Eugene McCloskey, Visakan Kadirkamanathan, et al. "Personalized estimation of one-year mortality risk after elective hip or knee arthroplasty for osteoarthritis." Bone & Joint Research 9, no. 11 (November 1, 2020): 808–20. http://dx.doi.org/10.1302/2046-3758.911.bjr-2020-0343.r1.
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Aims To develop and validate patient-centred algorithms that estimate individual risk of death over the first year after elective joint arthroplasty surgery for osteoarthritis. Methods A total of 763,213 hip and knee joint arthroplasty episodes recorded in the National Joint Registry for England and Wales (NJR) and 105,407 episodes from the Norwegian Arthroplasty Register were used to model individual mortality risk over the first year after surgery using flexible parametric survival regression. Results The one-year mortality rates in the NJR were 10.8 and 8.9 per 1,000 patient-years after hip and knee arthroplasty, respectively. The Norwegian mortality rates were 9.1 and 6.0 per 1,000 patient-years, respectively. The strongest predictors of death in the final models were age, sex, body mass index, and American Society of Anesthesiologists grade. Exposure variables related to the intervention, with the exception of knee arthroplasty type, did not add discrimination over patient factors alone. Discrimination was good in both cohorts, with c-indices above 0.76 for the hip and above 0.70 for the knee. Time-dependent Brier scores indicated appropriate estimation of the mortality rate (≤ 0.01, all models). Conclusion Simple demographic and clinical information may be used to calculate an individualized estimation for one-year mortality risk after hip or knee arthroplasty ( https://jointcalc.shef.ac.uk ). These models may be used to provide patients with an estimate of the risk of mortality after joint arthroplasty. Cite this article: Bone Joint Res 2020;9(11):808–820.
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Cha, Yong-Han, Young-Kyun Lee, Seok-Hyung Won, Jung Wee Park, Yong-Chan Ha, and Kyung-Hoi Koo. "Urinary retention after total joint arthroplasty of hip and knee: Systematic review." Journal of Orthopaedic Surgery 28, no. 1 (January 1, 2020): 230949902090513. http://dx.doi.org/10.1177/2309499020905134.
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Purpose: Postoperative urinary retention (POUR) is a common complication after total joint arthroplasties (TJAs). The POUR is managed with urinary catheterization, which is associated with a risk of urinary tract infection and subsequent periprosthetic joint infection. The purpose of this review was to afford a comprehensive understanding of POUR and its management. Methods: We identified 15 original articles concerning POUR after TJA, which were published from January 2010 to February 2019. The diagnostic method, incidence, risk factors, and management of POUR of the 15 studies were reviewed. Results: The incidence of POUR was ranged from 4.1% to 46.3%. Ultrasound was used for the detection of POUR among the total of the 15 studies. The following factors of old age, male gender, benign prostatic hypertrophy, history of urinary retention, spinal/epidural anesthesia, excessive fluid administration, patient-controlled analgesia, the use of opiates, underlying comorbidities, and poor American Society of Anesthesiologists (ASA) grade were risk factors for POUR. Most of the studies did not use indwelling catheterization during surgery. The POUR patients were managed with intermittent catheterization. The most common volume criterion for bladder catheterization was 400 mL. In inevitable use of an indwelling catheter, it should be removed within 48 h. Conclusions: This review provided an up-to-date guide for the detection and management of POUR. Level of Evidence: Level III.
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Karczewski, Daniel, Yi Ren, Octavian Andronic, Doruk Akgün, Carsten Perka, Michael Müller, and Arne Kienzle. "Candida periprosthetic joint infections — risk factors and outcome between albicans and non-albicans strains." International Orthopaedics 46, no. 3 (November 16, 2021): 449–56. http://dx.doi.org/10.1007/s00264-021-05214-y.
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Abstract Background Despite its scarcity, fungal periprosthetic joint infection (PJI) is of great clinical relevance as diagnosis and treatment are highly challenging. Previous analyses focused on the treatment rather than the role of the causative fungal agent on clinical outcome. This is the largest study of its kind to evaluate Candida strain–dependent differences in patients with fungal PJI. Methods We retrospectively analyzed 29 patients who underwent surgical intervention due to Candida hip or knee PJI in our department from 2010 to 2018. PJI was defined according to IDSA, recurrent PJI according to modified Delphi consensus criteria. Statistical analysis was performed using t-test, chi-square test with Yates correction, and log rank test. Results Besides age and affected joint, no significant differences were found between Candida albicans and non-albicans PJI patients (75.83 versus 64.11 years, p = 0.012; 12 hip versus two knee cases, p = 0.013). Most patients received two- (27.59%) or three-stage exchange surgery (41.38%). There was a statistical trend towards an increase in surgery needed in non-albicans Candida PJI (2.92 versus 2.12; p = 0.103). After initial Candida PJI treatment, functional prosthesis implantation was achieved in 72.41% of all patients. At last follow-up, infection-free survival was at 26.79% in Candida albicans versus 72.00% in non-albicans PJI (p = 0.046). Conclusions In this study, we found infection-free survival rates to be significantly decreased in patients with albicans compared to non-albicans Candida PJI. While age and affected joint might play a confounding role, we speculate the causative pathogen to play a decisive role in disease progression.
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Ahmed, Syed S., Fahima Begum, Babar Kayani, and Fares S. Haddad. "Risk factors, diagnosis and management of prosthetic joint infection after total hip arthroplasty." Expert Review of Medical Devices 16, no. 12 (November 25, 2019): 1063–70. http://dx.doi.org/10.1080/17434440.2019.1696673.
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Zhang, Xingen, Gang Shi, Xianjie Sun, Wei Zheng, Xueping Lin, and Guiqian Chen. "Factors Influencing the Outcomes of Artificial Hip Replacements." Cells Tissues Organs 206, no. 4-5 (2018): 254–62. http://dx.doi.org/10.1159/000500518.
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Hip replacement is one of the most successful surgeries in the clinic for the removal of painful joints. Hip osteoarthritis and femoral head necrosis are the 2 main reasons for hip replacement. Several factors are associated with the outcomes of surgery. Nonsurgical factors include gender, age, body mass index, prosthetic material, and risk factors. Surgical factors are anesthesia, postoperative complications, and rehabilitation. Considering the increasing demand for hip arthroplasty and the rise in the number of revision operations, it is imperative to understand factor-related progress and how modifications of these factors promotes recovery following hip replacement. In this review, we first summarize recent findings regarding crucial factors that influence the outcomes of artificial hip replacement surgery. These findings not only show the time-specific effect for the treatment and recovery from hip arthroplasty in the clinic, but also provide suitable choices for different individuals for clinicians to consider. This, in turn, will help to develop the best possible postoperative program for specific patients.
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Braginа, S. V., V. P. Moskalev, A. L. Petrushin, and P. A. Berezin. "Perioperative prognosis of infectious complications after total hip and knee arthroplasties. Part I." Genij Ortopedii 27, no. 5 (October 2021): 363–644. http://dx.doi.org/10.18019/1028-4427-2021-27-5-636-644.
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Abstract. Introduction The number of total joint arthroplasties performed globally has increased over time, and the projected growth for total knee arthroplasty (TKA) and total hip arthroplasty (THA) in 2030-2050 is associated with an increase in the number of surgical complications, such as periprosthetic joint infection (PJI). Perioperative modifiable risk factors can be altered to help improve rates of the devastating scenario. The purpose of the review was to systematize information on modifiable risk factors for PJI after THA and TKA and the ways to improve them. Material and methods Scientific literature search was performed via web-based services of PubMed, eLibrary, Scopus, Dimensions. The search depth was 30 years. Results Modifiable risk factors were shown to be associated with the patient's condition, medical history, current status, intraoperative and postoperative surgical options. Well-established modifiable risk factors include tobacco use, alcohol consumption, excess body weight, obesity, malnutrition, duration of surgery, postoperative wound hematoma. Discussion Timely diagnosed modifiable risk factors for PJI can be improved at the preparation stage, perioperatively and postoperatively. The interaction of inpatient and outpatient hospital services in the perioperative period is essential for reducing the risk of PJI after THA and TKA.
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Konow, Tobias, Johanna Baetz, Oliver Melsheimer, Alexander Grimberg, and Michael Morlock. "Factors influencing periprosthetic femoral fracture risk." Bone & Joint Journal 103-B, no. 4 (April 1, 2021): 650–58. http://dx.doi.org/10.1302/0301-620x.103b4.bjj-2020-1046.r2.
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Aims Periprosthetic femoral fractures (PPF) are a serious complication of total hip arthroplasty (THA) and are becoming an increasingly common indication for revision arthroplasty with the ageing population. This study aimed to identify potential risk factors for PPF based on an analysis of registry data. Methods Cases recorded with PPF as the primary indication for revision arthroplasty in the German Arthroplasty Registry (Endoprothesenregister Deutschland (EPRD)), as well as those classified as having a PPF according to the International Classification of Diseases (ICD) codes in patients’ insurance records were identified from the complete datasets of 249,639 registered primary hip arthroplasties in the EPRD and included in the analysis. Results The incidence of PPFs was higher (24.6%; 1,483) than reported in EPRD annual reports listing PPF as the main reason for revision (10.9%; 654). The majority of fractures occurred intraoperatively and were directly related to the implantation process. Patients who were elderly, female, or had comorbidities were at higher risk of PPFs (p < 0.001). German hospitals with a surgical volume of < 300 primary procedures per year had a higher rate of PPFs (p < 0.001). The use of cemented and collared prostheses had a lower fracture risk PPF compared to uncemented and collarless components, respectively (both p < 0.001). Collared prostheses reduced the risk of PPF irrespective of the fixation method and hospital’s surgical volume. Conclusion The high proportion of intraoperative fractures emphasises the need to improve surgeon training and surgical technique. Registry data should be interpreted with caution because of potential differences in coding standards between institutions. Cite this article: Bone Joint J 2021;103-B(4):650–658.
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Noori, Naudereh, Charles Myerson, Timothy Charlton, and David Thordarson. "Is Antibiotic Prophylaxis Necessary Before Dental Procedures in Patients Post Total Ankle Arthroplasty?" Foot & Ankle International 40, no. 2 (November 8, 2018): 237–41. http://dx.doi.org/10.1177/1071100718809454.
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Background: The need for dental antibiotic prophylaxis after orthopedic surgery remains unclear. Current recommendations are based on patients with total hip and total knee arthroplasties. We investigated available evidence regarding the need for dental antibiotic prophylaxis in patients post foot and ankle surgery, specifically total ankle arthroplasty. Additionally, we examined the microbiology behind the risk of transient bacteremia from dental procedures and whether this leads to an increased risk for postoperative infection in foot and ankle surgery. Methods: We performed a MEDLINE literature review of English articles between 1980 and 2018 on patients with prosthetic joints undergoing dental work, and studies evaluating hematogenous prosthetic joint infection (PJI) and dental antibiotic prophylaxis. We additionally included articles on PJI post total ankle arthroplasty, as well as committee guidelines. Results: There is no literature at present that evaluates transient bacteremia with dental procedures in patients following foot and ankle surgery. The data on this topic are isolated to PJI rates in the context of hip and total knee arthroplasty. This is of particular interest as rates of total ankle arthroplasty PJI have been reported to be 2- to 4-fold higher than in hip and total knee arthroplasty. Conclusion: The concern for postoperative infection due to transient bacteremia without dental antibiotic prophylaxis can be extrapolated to patients undergoing foot and ankle surgeries. Some data suggest that oral cavity bacteria can seed a prosthetic joint, though no clear relationship has been demonstrated. Similar risk factors have been identified between hip and knee PJI and total ankle arthroplasty. In light of the absence of scrutiny of and guidelines on this topic in foot and ankle surgery, it may be advisable to apply similar principles to decision-making in patients after foot and ankle surgery. Level of Evidence: Level III, systematic review.
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Blom, Ashley W., Andrew D. Beswick, Amanda Burston, Fran E. Carroll, Kirsty Garfield, Rachael Gooberman-Hill, Shaun Harris, et al. "Infection after total joint replacement of the hip and knee: research programme including the INFORM RCT." Programme Grants for Applied Research 10, no. 10 (November 2022): 1–190. http://dx.doi.org/10.3310/hdwl9760.
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Background People with severe osteoarthritis, other joint conditions or injury may have joint replacement to reduce pain and disability. In the UK in 2019, over 200,000 hip and knee replacements were performed. About 1 in 100 replacements becomes infected, and most people with infected replacements require further surgery. Objectives To investigate why some patients are predisposed to joint infections and how this affects patients and the NHS, and to evaluate treatments. Design Systematic reviews, joint registry analyses, qualitative interviews, a randomised controlled trial, health economic analyses and a discrete choice questionnaire. Setting Our studies are relevant to the NHS, to the Swedish health system and internationally. Participants People with prosthetic joint infection after hip or knee replacement and surgeons. Interventions Revision of hip prosthetic joint infection with a single- or two-stage procedure. Main outcome measures Long-term patient-reported outcomes and reinfection. Cost-effectiveness of revision strategies over 18 months from two perspectives: health-care provider and Personal Social Services, and societal. Data sources National Joint Registry; literature databases; published cohort studies; interviews with 67 patients and 35 surgeons; a patient discrete choice questionnaire; and the INFORM (INFection ORthopaedic Management) randomised trial. Review methods Systematic reviews of studies reporting risk factors, diagnosis, treatment outcomes and cost comparisons. Individual patient data meta-analysis. Results In registry analyses, about 0.62% and 0.75% of patients with hip and knee replacement, respectively, had joint infection requiring surgery. Rates were four times greater after aseptic revision. The costs of inpatient and day-case admissions in people with hip prosthetic joint infection were about five times higher than those in people with no infection, an additional cost of > £30,000. People described devastating effects of hip and knee prosthetic joint infection and treatment. In the treatment of hip prosthetic joint infection, a two-stage procedure with or without a cement spacer had a greater negative impact on patient well-being than a single- or two-stage procedure with a custom-made articulating spacer. Surgeons described the significant emotional impact of hip and knee prosthetic joint infection and the importance of a supportive multidisciplinary team. In systematic reviews and registry analyses, the risk factors for hip and knee prosthetic joint infection included male sex, diagnoses other than osteoarthritis, high body mass index, poor physical status, diabetes, dementia and liver disease. Evidence linking health-care setting and surgeon experience with prosthetic joint infection was inconsistent. Uncemented fixation, posterior approach and ceramic bearings were associated with lower infection risk after hip replacement. In our systematic review, synovial fluid alpha-defensin and leucocyte esterase showed high diagnostic accuracy for prosthetic joint infection. Systematic reviews and individual patient data meta-analysis showed similar reinfection outcomes in patients with hip or knee prosthetic joint infection treated with single- and two-stage revision. In registry analysis, there was a higher rate of early rerevision after single-stage revision for hip prosthetic joint infection, but, overall, 40% fewer operations are required as part of a single-stage procedure than as part of a two-stage procedure. The treatment of hip or knee prosthetic joint infection with early debridement and implant retention may be effective in > 60% of cases. In the INFORM randomised controlled trial, 140 patients with hip prosthetic joint infection were randomised to single- or two-stage revision. Eighteen months after randomisation, pain, function and stiffness were similar between the randomised groups (p = 0.98), and there were no differences in reinfection rates. Patient outcomes improved earlier in the single-stage than in the two-stage group. Participants randomised to a single-stage procedure had lower costs (mean difference –£10,055, 95% confidence interval –£19,568 to –£542) and higher quality-adjusted life-years (mean difference 0.06, 95% confidence interval –0.07 to 0.18) than those randomised to a two-stage procedure. Single-stage was the more cost-effective option, with an incremental net monetary benefit at a threshold of £20,000 per quality-adjusted life-year of £11,167 (95% confidence interval £638 to £21,696). In a discrete choice questionnaire completed by 57 patients 18 months after surgery to treat hip prosthetic joint infection, the most valued characteristics in decisions about revision were the ability to engage in valued activities and a quick return to normal activity. Limitations Some research was specific to people with hip prosthetic joint infection. Study populations in meta-analyses and registry analyses may have been selected for joint replacement and specific treatments. The INFORM trial was not powered to study reinfection and was limited to 18 months’ follow-up. The qualitative study subgroups were small. Conclusions We identified risk factors, diagnostic biomarkers, effective treatments and patient preferences for the treatment of hip and knee prosthetic joint infection. The risk factors include male sex, diagnoses other than osteoarthritis, specific comorbidities and surgical factors. Synovial fluid alpha-defensin and leucocyte esterase showed high diagnostic accuracy. Infection is devastating for patients and surgeons, both of whom describe the need for support during treatment. Debridement and implant retention is effective, particularly if performed early. For infected hip replacements, single- and two-stage revision appear equally efficacious, but single-stage has better early results, is cost-effective at 18-month follow-up and is increasingly used. Patients prefer treatments that allow full functional return within 3–9 months. Future work For people with infection, develop information, counselling, peer support and care pathways. Develop supportive care and information for patients and health-care professionals to enable the early recognition of infections. Compare alternative and new treatment strategies in hip and knee prosthetic joint infection. Assess diagnostic methods and establish NHS diagnostic criteria. Study registration The INFORM randomised controlled trial is registered as ISRCTN10956306. All systematic reviews were registered in PROSPERO (as CRD42017069526, CRD42015023485, CRD42018106503, CRD42018114592, CRD42015023704, CRD42017057513, CRD42015016559, CRD42015017327 and CRD42015016664). Funding This project was funded by the National Institute for Health and Care Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 10, No. 10. See the NIHR Journals Library website for further project information.
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Qu, Hao, Haochen Mou, Keyi Wang, Huimin Tao, Xin Huang, Xiaobo Yan, Nong Lin, and Zhaoming Ye. "Risk factor investigation for hip dislocation after periacetabular tumour resection and endoprosthetic reconstruction via thin-slice CT-based 3D model." Bone & Joint Journal 104-B, no. 10 (October 1, 2022): 1180–88. http://dx.doi.org/10.1302/0301-620x.104b10.bjj-2022-0265.
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Aims Dislocation of the hip remains a major complication after periacetabular tumour resection and endoprosthetic reconstruction. The position of the acetabular component is an important modifiable factor for surgeons in determining the risk of postoperative dislocation. We investigated the significance of horizontal, vertical, and sagittal displacement of the hip centre of rotation (COR) on postoperative dislocation using a CT-based 3D model, as well as other potential risk factors for dislocation. Methods A total of 122 patients who underwent reconstruction following resection of periacetabular tumour between January 2011 and January 2020 were studied. The risk factors for dislocation were investigated with univariate and multivariate logistic regression analysis on patient-specific, resection-specific, and reconstruction-specific variables. Results The dislocation rate was 13.9% (n = 17). The hip COR was found to be significantly shifted anteriorly and inferiorly in most patients in the dislocation group compared with the non-dislocation group. Three independent risk factors were found to be related to dislocation: resection of gluteus medius (odds ratio (OR) 3.68 (95% confidence interval (CI) 1.24 to 19.70); p = 0.039), vertical shift of COR > 18 mm (OR 24.8 (95% CI 6.23 to 128.00); p = 0.001), and sagittal shift of COR > 20 mm (OR 6.22 (95% CI 1.33 to 32.2); p = 0.026). Conclusion Among the 17 patients who dislocated, 70.3% (n = 12) were anterior dislocations. Three independent risk factors were identified, suggesting the importance of proper restoration of the COR and the role of the gluteus medius in maintaining hip joint stability. Cite this article: Bone Joint J 2022;104-B(10):1180–1188.
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Ingnam, Sisham, Jennifer Flaherty, Mark Lustberg, Julie E. Mangino, and Shandra R. Day. "1242. Evaluation of Risk Factors for Development of Total Hip Arthroplasty (THA) Surgical Site Infections (SSI)." Open Forum Infectious Diseases 6, Supplement_2 (October 2019): S447. http://dx.doi.org/10.1093/ofid/ofz360.1105.
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Abstract Background THA is one of the most commonly performed surgeries for pathologic diseases of the hip. Multiple risk factors have been identified for SSI including: female gender, previous joint surgery, hematoma, joint dislocation, intraarticular glucocorticoid injection, rheumatoid arthritis, uncontrolled diabetes, anemia, malnutrition, and an immunosuppressed state. The objective of our study is to evaluate obesity (body mass index (BMI) >30) as an independent risk factor for THA SSI and identify other risk factors for SSI Methods A retrospective case–control (1:3) matched observation study was conducted from January 1, 2014–June 30, 2016. Patients with a THA SSI were identified using NHSN definitions and 3 controls were matched for sex and month of surgery for each SSI case. Patient information was extracted through chart review including BMI, revision surgery, chronic kidney disease (CKD), diabetes mellitus (DM), anemia, malnutrition, smoking, surgery duration, steroid use, pre-operative chlorhexidine (CHG) bathing and nasal povidone–iodine (PI) compliance. Multivariate analysis using a conditional logistic regression model was performed. Results Among 906 THA, 29 patients developed an SSI with 87 matched patients over the 2.5 years. The mean age in the SSI group was 61.0 years, and 37.9% were male. Mean age in the control group was 63.1, and 40.1% were male. In both groups, the most common indications for surgery were osteoarthritis followed by osteonecrosis and malignancy. Results of multivariate analysis identified five independent risk factors for SSI (see Table 1). Conclusion Obesity (BMI >30) was identified as an independent risk factor for THA SSI as well as CKD, steroid use and revision arthroplasty. While these risk factors are not easily modifiable, noncompliance with pre-operative CHG bathing and PI administration were also identified as significant SSI risk factor. These findings emphasize the importance of evaluating patients for SSI risk factors including obesity and improving compliance with all pre-operative SSI reduction measures. Disclosures All authors: No reported disclosures.
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Jakobsen, Stig Storgaard, Søren Overgaard, Kjeld Søballe, Ole Ovesen, Bjarne Mygind-Klavsen, Christian Andreas Dippmann, Michael Ulrich Jensen, Jens Stürup, and Jens Retpen. "The interface between periacetabular osteotomy, hip arthroscopy and total hip arthroplasty in the young adult hip." EFORT Open Reviews 3, no. 7 (July 2018): 408–17. http://dx.doi.org/10.1302/2058-5241.3.170042.
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Hip pain is highly prevalent in both the younger and the elderly population. In older patients, pain arising from osteoarthritis (OA) is most frequent, whereas in younger patients, non-degenerative diseases are more often the cause of pain. The pain may be caused by hip dysplasia and femoroacetabular impingement (FAI). Abnormal mechanics of the hip are hypothesized by some authors to cause up to 80% of OA in the hip. Therefore, correction of these abnormalities is of obvious importance when treating young patients with hip pain. Hip dysplasia can be diagnosed by measuring a CE angle < 25° on a plain standing radiograph of the pelvis. Dysplastic or retroverted acetabulum with significant symptoms should receive a periacetabular osteotomy (PAO). FAI with significant symptoms should be treated by adequate resection and, if necessary, labrum surgery. If risk factors for poor outcome of joint-preserving surgery are present (age > 45 to 50 years, presence of OA, joint space < 3 mm or reduced range of motion), the patient should be offered a total hip arthroplasty (THA) instead of PAO. THA can be performed following PAO with outcomes similar to a primary THA. Hip arthroscopy is indicated in FAI (cam and pincer) and/or for labral tears. Cite this article: EFORT Open Rev 2018;3:408-417. DOI: 10.1302/2058-5241.3.170042
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Uchida, Soshi, Kazuha Kizaki, Fumitaka Hirano, Hal David Martin, and Akinori Sakai. "Postoperative Deep Gluteal Syndrome After Hip Arthroscopic Surgery." Orthopaedic Journal of Sports Medicine 8, no. 9 (September 1, 2020): 232596712095111. http://dx.doi.org/10.1177/2325967120951118.
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Background: Deep gluteal syndrome (DGS) is an uncommon source of buttock and groin pain, resulting from entrapment of the sciatic nerve in the deep gluteal space. The incidence and risk factors of postoperative DGS after primary hip arthroscopic surgery are currently unknown. Purpose: To investigate the incidence and risk factors of postoperative DGS after primary hip arthroscopic surgery. Study Design: Case-control study; Level of evidence, 3. Methods: This study reviewed 1167 patients who underwent arthroscopic surgery between 2010 and 2018 by a single surgeon at a single center in Japan. DGS was defined using the seated piriformis stretch test, active hamstring test, and evidence of a hypertrophic sciatic nerve on magnetic resonance imaging. Overall, 11 of 1167 patients were diagnosed with DGS postoperatively. The DGS group (n = 11) was compared with the non-DGS group (n = 1156). Patient age, sex, body mass index (BMI), generalized joint laxity (GJL; Beighton score >6), number of hip arthroscopic procedures, and radiographic parameters including lateral center-edge angle, Sharp angle, vertical center anterior angle, Tönnis angle, alpha angle, ischiofemoral distance, ischiofemoral space, and quadratus femoris space were compared. The prevalence of developmental dysplasia of the hip (DDH) and borderline DDH (BDDH) was also compared. Logistic regression analysis was conducted to identify potential predictors for a postoperative DGS diagnosis. Results: The incidence of postoperative DGS in our study was 0.9%. Female sex (male:female ratio: 0:11 in DGS group vs 568:588 in non-DGS group; P < .01), mean number of hip surgical procedures (1.8 ± 0.9 in DGS group vs 1.1 ± 0.4 in non-DGS group; P < .01), and GJL ( P < .01) were significantly higher in the DGS group, while the mean BMI was significantly lower in the DGS group (19.8 ± 1.8 vs 22.7 ± 3.6 kg/m2, respectively; P < .01). Radiographic parameters were not significantly different between groups. Logistic regression analysis revealed that female sex (odds ratio [OR], 22.0 [95% CI, 1.29-374.56]), multiple surgical procedures (OR, 7.8 [95% CI, 2.36-25.95]), GJL (OR, 40.9 [95% CI, 8.74-191.70]), lower BMI (OR, 0.77 [95% CI, 0.644-0.914]), and DDH/BDDH (OR, 18.1 [95% CI, 2.30-142.10]) were potential predictors of postoperative DGS. Conclusion: The incidence of postoperative DGS in our study was 0.9%. The predictors for postoperative DGS after hip arthroscopic surgery were female sex, GJL, multiple hip surgical procedures, and DDH/BDDH. Although hip arthroscopic surgery can provide favorable clinical outcomes, surgeons should be aware of the risk factors for DGS as a complication of hip arthroscopic surgery.
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Rosteius, Thomas, Valentin Rausch, Simon Pätzholz, Sebastian Lotzien, Hinnerk Baecker, Thomas Armin Schildhauer, and Jan Geßmann. "Incidence and risk factors for heterotopic ossification following periprosthetic joint infection of the hip." Archives of Orthopaedic and Trauma Surgery 139, no. 9 (June 11, 2019): 1307–14. http://dx.doi.org/10.1007/s00402-019-03215-6.
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Artyukh, V. A., S. A. Bozhkova, R. M. Tikhilov, A. V. Yarmilko, and Yu V. Muravyova. "Risk factors for lethal outcomes after surgical treatment of patients with chronic periprosthetic hip joint infection." Genij Ortopedii 27, no. 5 (October 2021): 555–61. http://dx.doi.org/10.18019/1028-4427-2021-27-5-555-561.
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Abstract. Introduction Periprosthetic joint infections (PJI) are serious complications of total hip arthroplasty (THA) and affect the patient's life expectancy. The aim of the study was to identify independent factors influencing the risk of death in patients with PJI after revision THA. Materials and methods The study included 51 lethal outcomes in patients with chronic PJI of the hip. Results and discussion In our cohort of 434 patients, 13 (2.99 %) patients died within the first year after surgery (p > 0.05), which is 2.2 times less than similar published data. The result of gender analysis showed no statistically significant differences in the risk of death between men and women (OR1.05 CI 0.59–1.89, p = 0.87). It was found that in patients over 70 years old, the risk of death was significantly higher (OR 2.05 CI 1.09–3.87, p = 0.031). Additional independent risk factors of death are diseases of the cardiovascular system. It was not possible to find a statistically significant effect of the nature of infection on the risk of death: no growth (OR 2.23, CI 0.52–9.61), monomicrobial infection (OR 1.98, CI 0.45–8, 73), polymicrobial infection (OR 3.2, CI 0.71–14.45, p > 0.05). Conclusion The mortality rate during the first year after revision THA in patients with PJI was 2.99 %, which is lower than the results of other researchers. In the next 2–3 years, the rate of death increases 3.9 times. The main independent risk factors are the age of patients and concomitant diseases of the cardiovascular system.
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Kjærvik, Cato, Jan-Erik Gjertsen, Eva Stensland, Jurate Saltyte-Benth, and Odd Soereide. "Modifiable and non-modifiable risk factors in hip fracture mortality in Norway, 2014 to 2018." Bone & Joint Journal 104-B, no. 7 (July 1, 2022): 884–93. http://dx.doi.org/10.1302/0301-620x.104b7.bjj-2021-1806.r1.
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Aims This study aimed to identify risk factors (patient, healthcare system, and socioeconomic) for mortality after hip fractures and estimate their relative importance. Further, we aimed to elucidate mortality and survival patterns following fractures and the duration of excess mortality. Methods Data on 37,394 hip fractures in the Norwegian Hip Fracture Register from January 2014 to December 2018 were linked to data from the Norwegian Patient Registry, Statistics Norway, and characteristics of acute care hospitals. Cox regression analysis was performed to estimate risk factors associated with mortality. The Wald statistic was used to estimate and illustrate relative importance of risk factors, which were categorized in modifiable (healthcare-related) and non-modifiable (patient-related and socioeconomic). We calculated standardized mortality ratios (SMRs) comparing deaths among hip fracture patients to expected deaths in a standardized reference population. Results Mean age was 80.2 years (SD 11.4) and 67.5% (n = 25,251) were female. Patient factors (male sex, increasing comorbidity (American Society of Anesthesiologists grade and Charlson Comorbidity Index)), socioeconomic factors (low income, low education level, living in a healthcare facility), and healthcare factors (hip fracture volume, availability of orthogeriatric services) were associated with increased mortality. Non-modifiable risk factors were more strongly associated with mortality than modifiable risk factors. The SMR analysis suggested that cumulative excess mortality among hip fracture patients was 16% in the first year and 41% at six years. SMR was 2.48 for the six-year observation period, most pronounced in the first year, and fell from 10.92 in the first month to 3.53 after 12 months and 2.48 after six years. Substantial differences in median survival time were found, particularly for patient-related factors. Conclusion Socioeconomic, patient-, and healthcare-related factors all contributed to excess mortality, and non-modifiable factors had stronger association than modifiable ones. Hip fractures contributed to substantial excess mortality. Apparently small survival differences translate into substantial disparity in median survival time in this elderly population. Cite this article: Bone Joint J 2022;104-B(7):884–893.
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Mellner, Carl, Thomas Eisler, Björn Knutsson, and Sebastian Mukka. "Early Periprosthetic Joint Infection and Debridement, Antibiotics and Implant Retention in Arthroplasty for Femoral Neck Fracture." HIP International 27, no. 4 (January 31, 2017): 349–53. http://dx.doi.org/10.5301/hipint.5000467.
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Introduction Periprosthetic joint infection (PJI) is a severe complication of hip arthroplasty for femoral neck fractures (FNF). Debridement, antibiotics and implant retention (DAIR) is recommended in early PJI in association with stable implants. Few studies have evaluated the outcome of DAIR in this fragile population. The purpose of this study was to analyse risk factors for PJI and the short-term outcome of DAIR in FNF patients treated with a hip arthroplasty. Methods A consecutive series of 736 patients (median age 81 years, 490 women, 246 men) had been treated with either a total hip arthroplasty or a hemi hip arthroplasty for a displaced FNF at our institution. 33 (4.5%) of the hips developed an early (<6 weeks post operatively) PJI and 28 (3.8%) of these patients were treated according to the DAIR-protocol. Regression analyses were performed to assess risk factors for developing a PJI. Results DAIR eradicated the PJI in 82% (23/28) of patients at a median follow-up of 31 (SD 29.8) months of the infected hips. The logistic regression analysis indicated that 2 or more changes of the primary dressing due to wound bleeding was associated with an increased risk for developing PJI (OR 4.9, 95% 1.5 to 16.1, p = 0.01). Conclusions The short-term success-rate of DAIR was unexpectedly favourable in this fragile patient population; the results being on par with that after PJI in osteoarthritis patients. The need for repeated bandage changes postoperatively indicates an increased risk for PJI and should prompt early surgical intervention.
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Gibbs, Victoria N., Robert A. McCulloch, Paula Dhiman, Andrew McGill, Adrian H. Taylor, Antony J. R. Palmer, and Ben J. L. Kendrick. "Modifiable risk factors for mortality in revision total hip arthroplasty for periprosthetic fracture." Bone & Joint Journal 102-B, no. 5 (May 2020): 580–85. http://dx.doi.org/10.1302/0301-620x.102b5.bjj-2019-1673.r1.
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Aims The aim of this study was to identify modifiable risk factors associated with mortality in patients requiring revision total hip arthroplasty (THA) for periprosthetic hip fracture. Methods The electronic records of consecutive patients undergoing revision THA for periprosthetic hip fracture between December 2011 and October 2018 were reviewed. The data which were collected included age, sex, body mass index (BMI), American Society of Anesthesiologists (ASA) classification, the preoperative serum level of haemoglobin, time to surgery, operating time, blood transfusion, length of hospital stay, and postoperative surgical and medical complications. Univariate and multivariate logistic regression analyses were used to determine independent modifiable factors associated with mortality at 90 days and one year postoperatively. Results A total of 203 patients were identified. Their mean age was 78 years (44 to 100), and 108 (53%) were female. The median time to surgery was three days (interquartile range (IQR) 2 to 5). The mortality rate at one year was 13.8% (n = 28). The commonest surgical complication was dislocation (n = 22, 10.8%) and the commonest medical complication within 90 days of surgery was hospital-acquired pneumonia (n = 25, 12%). Multivariate analysis showed that the rate of mortality one year postoperatively was five-fold higher in patients who sustained a dislocation (odds ratio (OR) 5.03 (95% confidence interval (CI) 1.60 to 15.83); p = 0.006). The rate of mortality was also four-fold higher in patients who developed hospital-acquired pneumonia within 90 days postoperatively (OR 4.43 (95% CI 1.55 to 12.67); p = 0.005). There was no evidence that the time to surgery was a risk factor for death at one year. Conclusion Dislocation and hospital-acquired pneumonia following revision THA for a periprosthetic fracture are potentially modifiable risk factors for mortality. This study suggests that surgeons should consider increasing constraint to reduce the risk of dislocation, and the early involvement of a multidisciplinary team to reduce the risk of hospital-acquired pneumonia. We found no evidence that the time to surgery affected mortality, which may allow time for medical optimization, surgical planning, and resource allocation. Cite this article: Bone Joint J 2020;102-B(5):580–585.
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Young, Megan E., Simon C. Mears, Ahmed B. Sallam, Riley N. Sanders, C. Lowry Barnes, and Jeffrey B. Stambough. "Corneal Abrasions in Total Joint Arthroplasty." Geriatric Orthopaedic Surgery & Rehabilitation 12 (January 2021): 215145932110601. http://dx.doi.org/10.1177/21514593211060101.
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Introduction Corneal abrasion (CA) is the most common ocular complication in patients undergoing nonocular surgery. Corneal abrasions can be caused by a variety of mechanisms, the most common being drying of the cornea due to reduced tear secretions, loss of eyelid reflex, and the loss of pain recognition during surgery. Though CA heals well with eye lubricants, it can result in significant ocular pain and some cases may go on to develop ocular complications. With the current switch to outpatient total joint replacement, CA could potentially lead to discharge delays. Materials and Methods We examined the results of a quality improvement project to reduce CA during general anesthesia to determine the rates of CA during hip and knee total joint replacement. We compared rates of CA for 6 months before and 6 months after the intervention. Results A total of 670 hip and knee arthroplasty procedures were performed during this period. Two events of CA occurred, one occurred before and one after the intervention to decrease eye injuries. Both incidences occurred during total hip arthroplasty (THA) procedures with the patient in the lateral decubitus position and recovered without long-term deficit. Discussion Surgeons and anesthesiologists alike should be cognizant of this avoidable complication and take precaution to protect the eyes during surgery, especially during THA when the patient is placed in the lateral decubitus position. Conclusion Corneal abrasion during total joint arthroplasty is a rare complication and is infrequently addressed in the literature. CA is mostly self-limiting, however, but may lead to patient dissatisfaction and to delays if same-day discharge is attempted. Preventative measures and attentive care may help reduce the incidence of CA in patients undergoing total joint arthroplasty. The lateral decubitus position and longer surgeries times are risk factors for CA.
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Schulz, Lucas, Darina Georgieva, and Ambar Haleem. "330. Risk Factors for Acute Kidney Injury after the Use of Antibiotic Loaded Bone Cement in Orthopedic Surgery – a Retrospective Case-control Study." Open Forum Infectious Diseases 7, Supplement_1 (October 1, 2020): S237. http://dx.doi.org/10.1093/ofid/ofaa439.526.
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Abstract Background As the number of joint replacement surgeries continues to rise, so does the number of joint infections. Many patients end up needing the implantation of antibiotic loaded bone cement (ALBC) to treat their infection. The use of localized high dose vancomycin, tobramycin, and gentamicin may be linked to acute kidney injury (AKI) in certain patients. Our hypothesis is that patients who developed AKI after receiving a joint spacer had a predisposition to AKI due to other comorbidities, high antibiotic doses in ALBC, immunosuppression, or the use of other nephrotoxic drugs pre-op. These patients may need close monitoring of their renal function and serum antibiotic levels after surgery. Methods We performed a chart review of 428 patients who underwent an orthopedic surgery that involved insertion of ALBC at our institution between 2015 and 2018. We excluded patients under age 18, those who had antibiotic irrigation only, trauma patients, non-arthroplasty surgeries (such as fractures and debridement of deep wounds), and patients with missing data for 30 days after the surgery. We identified 57 patients who fit our inclusion criteria and received a bone cement spacer or beads to treat an infection of the hip, knee, shoulder, or ankle. We matched patients who had AKI to 2 patients who did not have AKI. Matching was based on age (± 5 years), joint operated on, and antibiotics used. Results 15 patients showed an elevated serum creatinine level of over 1.2 within 30 days of surgery. 86.7% of these patients were male, their average age was 64.1 ± 6.2 years old, 40% had hip surgery, 46.7% knee surgery, 6.7% ankle, and 6.7% shoulder. All received vancomycin and tobramycin in Palacos bone cement. Compared to their case-control matches, these patients had more frequent use of immunosuppressive medication, a history of malignancy, a history of previous kidney disease, and obesity. The use of combined intravenous vancomycin and piperacillin-tazobactam post-operatively may also be linked to higher rates of AKI. Conclusion Immunosuppression, obesity, male gender, and history of kidney injury and cancer are factors associated with AKI after ALBC spacer implantation. Further analysis and study are needed to identify potential causation between ALBC use and AKI. Disclosures All Authors: No reported disclosures
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Uzoigwe, Chika E., Lawrence O'Leary, Jude Nduka, Daman Sharma, David Melling, Damon Simmons, and Simon Barton. "Factors associated with delirium and cognitive decline following hip fracture surgery." Bone & Joint Journal 102-B, no. 12 (December 1, 2020): 1675–81. http://dx.doi.org/10.1302/0301-620x.102b12.bjj-2019-1537.r3.
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Aims Postoperative delirium (POD) and postoperative cognitive decline (POCD) are common surgical complications. In the UK, the Best Practice Tariff incentivizes the screening of delirium in patients with hip fracture. Further, a National Hip Fracture Database (NHFD) performance indicator is the reduction in the incidence of POD. To aid in its recognition, we sought to determine factors associated with POD and POCD in patients with hip fractures. Methods We interrogated the NHFD data on patients presenting with hip fractures to our institution from 2016 to 2018. POD was determined using the 4AT score, as recommended by the NHFD and UK Department of Health. POCD was defined as a decline in Abbreviated Mental Test Score (AMTS) of two or greater. Using logistic regression, we adjusted for covariates to identify factors associated with POD and POCD. Results Of the 1,224 patients presenting in the study period, 1,023 had complete datasets for final analysis. POD was observed in 242 patients (25%). On multivariate analysis only preoperative AMTS and American Society of Anesthesiologists grade (ASA) were independent predictors of POD. Every point increase in AMTS was associated with a fall in the odds of POD by a factor of 0.60 (95% confidence interval (CI) 0.56 to 0.63, p < 0.001). Every grade increase in ASA led to a 1.7-fold increase in the odds of POD (95% CI 1.13 to 2.50, p = 0.009). A preoperative AMTS of less than 8 was strongly predictive of POD with area under the receiver operating characteristic of 0.86 (95% CI 0.84 to 0.89). Only ASA was predictive of POCD—every grade increase in ASA led to a 2.6-fold increase in the odds of POCD (95% CI 1.7 to 4.0, p < 0.001). Conclusion POD and POCD are common in the hip fracture patients. Preoperative AMTS and ASA are strong predictors of POD, and ASA predictive of POCD. This may aid in the earlier identification of those most at risk and suited for the patient consent and decision-making process. Cite this article: Bone Joint J 2020;102-B(12):1675–1681.
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Kayani, Babar, Elliot Onochie, Vijay Patil, Fahima Begum, Rory Cuthbert, David Ferguson, Jagmeet S. Bhamra, Aadhar Sharma, Peter Bates, and Fares S. Haddad. "The effects of COVID-19 on perioperative morbidity and mortality in patients with hip fractures." Bone & Joint Journal 102-B, no. 9 (September 1, 2020): 1136–45. http://dx.doi.org/10.1302/0301-620x.102b9.bjj-2020-1127.r1.
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Aims During the COVID-19 pandemic, many patients continue to require urgent surgery for hip fractures. However, the impact of COVID-19 on perioperative outcomes in these high-risk patients remains unknown. The objectives of this study were to establish the effects of COVID-19 on perioperative morbidity and mortality, and determine any risk factors for increased mortality in patients with COVID-19 undergoing hip fracture surgery. Methods This multicentre cohort study included 340 COVID-19-negative patients versus 82 COVID-19-positive patients undergoing surgical treatment for hip fractures across nine NHS hospitals in Greater London, UK. Patients in both treatment groups were comparable for age, sex, body mass index, fracture configuration, and type of surgery performed. Predefined perioperative outcomes were recorded within a 30-day postoperative period. Univariate and multivariate analysis were used to identify risk factors associated with increased risk of mortality. Results COVID-19-positive patients had increased postoperative mortality rates (30.5% (25/82) vs 10.3% (35/340) respectively, p < 0.001) compared to COVID-19-negative patients. Risk factors for increased mortality in patients with COVID-19 undergoing surgery included positive smoking status (hazard ratio (HR) 15.4 (95% confidence interval (CI) 4.55 to 52.2; p < 0.001) and greater than three comorbidities (HR 13.5 (95% CI 2.82 to 66.0, p < 0.001). COVID-19-positive patients had increased risk of postoperative complications (89.0% (73/82) vs 35.0% (119/340) respectively; p < 0.001), more critical care unit admissions (61.0% (50/82) vs 18.2% (62/340) respectively; p < 0.001), and increased length of hospital stay (mean 13.8 days (SD 4.6) vs 6.7 days (SD 2.5) respectively; p < 0.001), compared to COVID-19-negative patients. Conclusion Hip fracture surgery in COVID-19-positive patients was associated with increased length of hospital stay, more admissions to the critical care unit, higher risk of perioperative complications, and increased mortality rates compared to COVID-19-negative patients. Risk factors for increased mortality in patients with COVID-19 undergoing surgery included positive smoking status and multiple (greater than three) comorbidities. Cite this article: Bone Joint J 2020;102-B(9):1136–1145.
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Chou, Te-Feng Arthur, Hsuan-Hsiao Ma, Shang-Wen Tsai, Cheng-Fong Chen, Po-Kuei Wu, and Wei-Ming Chen. "Dialysis patients have comparable results to patients who have received kidney transplant after total joint arthroplasty: a systematic review and meta-analysis." EFORT Open Reviews 6, no. 8 (August 2021): 618–28. http://dx.doi.org/10.1302/2058-5241.6.200116.
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Patients with end-stage renal disease (ESRD) have inferior outcomes after hip and knee total joint arthroplasty (TJA), with higher risk for surgical site complications (SSC) and periprosthetic joint infection (PJI). We conducted a systematic review and meta-analysis regarding outcomes after hip and knee TJA in ESRD patients who have received dialysis or a kidney transplant (KT) using PubMed, MEDLINE, Cochrane Reviews, and Embase in order to: (1) determine the mortality and infection rate of TJA in patients receiving dialysis or KT and (2) to identify risk factors associated with the outcome. We included 22 studies and 9384 patients (dialysis, n = 8921, KT, n = 463). The overall mortality rate was 14.9% and was slightly higher in KT patients (dialysis vs. KT, 13.8% vs. 15.8%). The overall SSC rate was 3.4%, while dialysis and KT patients each had an incidence of 3.3% and 3.6%, respectively. For PJI, the overall rate was 3.9%, while the incidence for dialysis patients was 4.0% and for KT patients was 3.7%. Using multi-regression analysis, age, sex, the type of arthroplasty (knee or hip) performed, and the form of renal replacement therapy (dialysis or KT) were not significant risk factors. In patients on dialysis or who had received a KT, TJA is associated with a slight increase in mortality, SSC and PJI rates. Cite this article: EFORT Open Rev 2021;6:618-628. DOI: 10.1302/2058-5241.6.200116
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Goodman, Susan M., Vivian P. Bykerk, Edward DiCarlo, Ryan W. Cummings, Laura T. Donlin, Dana E. Orange, Annie Hoang, et al. "Flares in Patients with Rheumatoid Arthritis after Total Hip and Total Knee Arthroplasty: Rates, Characteristics, and Risk Factors." Journal of Rheumatology 45, no. 5 (March 15, 2018): 604–11. http://dx.doi.org/10.3899/jrheum.170366.
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Objective.Rates of total knee arthroplasty (TKA) and total hip arthroplasty (THA) remain high for patients with rheumatoid arthritis (RA), who are at risk of flaring after surgery. We aimed to describe rates, characteristics, and risk factors of RA flare within 6 weeks of THA and TKA.Methods.Patients with RA were recruited prior to elective THA and TKA surgery and prospectively followed. Clinicians evaluated RA clinical characteristics 0–2 weeks before and 6 weeks after surgery. Patients answered questions regarding disease activity including self-reported joint counts and flare status weekly for 6 weeks. Per standard of care, biologics were stopped before surgery, while glucocorticoids and methotrexate (MTX) were typically continued. Multivariable logistic regression was used to identify baseline characteristics associated with postsurgical RA flares.Results.Of 120 patients, the mean age was 62 years and the median RA duration 14.8 years. Ninety-eight (82%) met 2010/1987 American College of Rheumatology/European League Against Rheumatism criteria, 53 (44%) underwent THA (and the rest TKA), and 61 (51%) were taking biologics. By 6 weeks, 75 (63%) had flared. At baseline, flarers had significantly higher disease activity (as measured by the 28-joint Disease Activity Score), erythrocyte sedimentation rate, C-reactive protein, and pain. Numerically more flarers used biologics, but stopping biologics did not predict flares, and continuing MTX was not protective. A higher baseline disease activity predicted flaring by 6 weeks (OR 2.12, p = 0.02).Conclusion.Flares are frequent in patients with RA undergoing arthroplasty. Higher baseline disease activity significantly increases the risk. Although more patients stopping biologics flared, this did not independently predict flaring. The effect of early postsurgery flares requires further study.
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SINGH, JASVINDER A., JOSEPH KUNDUKULAM, DANIEL L. RIDDLE, VIBEKE STRAND, and PETER TUGWELL. "Early Postoperative Mortality Following Joint Arthroplasty: A Systematic Review." Journal of Rheumatology 38, no. 7 (July 2011): 1507–13. http://dx.doi.org/10.3899/jrheum.110280.
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Objective.To perform a systematic review of 30- and 90-day mortality rates in patients undergoing hip or knee arthroplasties.Methods.Five databases were searched for English-language studies of mortality in hip or knee arthroplasties and the following data were extracted: patient characteristics (age, sex, ethnicity), arthroplasty characteristics (unilateral vs bilateral, hip vs knee), system factors (hospital volume and surgeon volume), year of study, etc. Mortality rates were compared across variable categories; proportions were compared using relative risk ratios and 95% confidence intervals.Results.Out of 650 titles and abstracts, 80 studies qualified for analysis. Of these, 35%, 34%, and 31% of studies provided 30-, 90-, and > 90-day mortality rates. Overall 30-day mortality rates across all types of arthroplasties were 0.3%; 90-day, 0.7%. For those reports with specific rates, 30-day mortality was significantly higher in men than women [1.8% vs 0.4%, respectively; relative risk (RR) 3.93, 95% CI 3.30–4.68] and in bilateral versus unilateral procedures (0.5% vs 0.3%; RR 1.6, 95% CI 1.49–1.72), but no differences were noted by the underlying diagnosis of osteoarthritis (OA) versus rheumatoid arthritis (0.4% vs 0.3%; RR 0.77, 95% CI 0.48–1.24). 90-day mortality showed nonsignificant trends favoring women, OA as the underlying diagnosis, and unilateral procedures.Conclusion.Several demographic and surgical factors were associated with higher 30-day mortality rates following knee and hip arthroplasties. More studies are needed to examine the effect of body mass index, comorbidities, and other modifiable factors, in order to identify interventions to lower mortality rates following arthroplasty procedures.
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Nakashima, Hirotaka, Manabu Tsukamoto, Yasuo Ohnishi, Hajime Utsunomiya, Shiho Kanezaki, Akinori Sakai, and Soshi Uchida. "Clinical and Radiographic Predictors for Unsalvageable Labral Tear at the Time of Initial Hip Arthroscopic Management for Femoroacetabular Impingement." American Journal of Sports Medicine 47, no. 9 (June 24, 2019): 2029–37. http://dx.doi.org/10.1177/0363546519856018.
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Background:The acetabular labrum plays important roles in proprioception, nociception, synovial fluid seal effect, and static and dynamic joint stability and as a shock absorber. Clinical and radiographic risk factors for unsalvageable labral tear in femoroacetabular impingement (FAI) are not well established.Purpose:To identify predictors of unsalvageable labral tear during initial hip arthroscopic management of FAI.Study Design:Case-control study; Level of evidence, 3.Methods:Patients were included who underwent primary hip arthroscopic treatment for FAI between March 2009 and March 2014. Patients were excluded who had <2-year follow-up, underwent bilateral surgery, or had a history of surgery, osteoarthritis (Tönnis grade 2 or 3), and other diagnoses, including lateral center-edge angle <25° diagnosed as developmental hip dysplasia. Patients were divided into 2 groups according to their labral condition: reconstruction and refixation. Unsalvageable labral tear was defined as any irreparable labral tear, including severe degenerative tear, frayed labrum, labral ossification, flattened labrum, and failed prior repair during surgery. Univariate and multivariate analyses identified risk factors for segmental labral reconstruction. Patient-reported outcome scores and postoperative revision rates were also assessed.Results:Twenty-five hips (18 male, 7 female) and 126 hips (65 male, 61 female) were included in the reconstruction and refixation groups, respectively. The mean ± SD ages were 52.6 ± 15.0 and 36.5 ± 16.1 years in the reconstruction and refixation groups, respectively. In the reconstruction group, the mean modified Harris Hip Score significantly improved from 67.3 ± 14.9 preoperatively to 95.0 ± 8.1 at final follow-up ( P < .001), and the mean Nonarthritic Hip Score improved from 63.0 ± 18.3 preoperatively to 89.5 ± 10.1 at final follow-up ( P < .001). In the refixation group, the mean modified Harris Hip Score significantly improved from 69.2 ± 18.6 preoperatively to 93.0 ± 11.2 at final follow-up ( P < .001), and the mean Nonarthritic Hip Score improved from 60.7 ± 18.8 preoperatively to 88.6 ± 15.0 at final follow-up ( P < .001). No significant difference was noted in patient-reported outcome scores and revision hip arthroscopy rates. The rate of conversion of total hip arthroplasty was higher in the reconstruction group than in the refixation group. Risk factors for unsalvageable labral tear were age ≥45 years (odds ratio [OR], 8.83; P < .007), body mass index ≥23.1 kg/m2(OR, 13.05; P < .001), and vertical center anterior angle ≥36° (OR, 19.03; P < .001). Furthermore, in this study, unsalvageable labral tears were present in cases with at least 2 of the 3 risk factors.Conclusion:Age ≥45 years, body mass index ≥23.1 kg/m2, and vertical center anterior angle ≥36° are risk factors for unsalvageable labral tear at initial hip arthroscopic surgery for patients with FAI.
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Kamath, S., and D. Bramley. "Is ‘Clicky Hip’ a Risk Factor in Developmental Dysplasia of the Hip?" Scottish Medical Journal 50, no. 2 (May 2005): 56–58. http://dx.doi.org/10.1177/003693300505000205.
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Background: The role of the ‘clicky hip’ symptom as a prognostic predictor of developmental dysplasia of hip (DDH) is controversial. We aim to study the role of isolated hip clicks as a prognostic predictor of DDH. Material and methods: 235 babits with persisting or referred with clicky hip beyond six weeks of age were prospectively followed up to note the incidence of DDH. Of these 176 babies were referred for a hip click without additional risk factors. Results: 7 out of 176 cases (4 - IIa, 2 - IIb, 1 - IIc) had initial abnormal ultrasound examination based on Graf classification. However, all babies with isolated hip clicks eventually had normal hips on clinical and radiographic examination. Discussion: While screening of babies with clicky hips does help in diagnosing the odd case of DDH this is not consistently reproducible. Modifying the targeted ultrasound screening by including clicky hip as a risk factor will not reduce the incidence of missed cases. Isolated clicks in the hip joint beyond six weeks age are rarely a predictor of DDH. However when in doubt such cases should be referred to be reviewed by an orthopaedic surgeon or a radiologist experienced in hip ultrasound.
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Di Laura Frattura, Giorgio, Vittorio Bordoni, Pietro Feltri, Augusto Fusco, Christian Candrian, and Giuseppe Filardo. "Balance Remains Impaired after Hip Arthroplasty: A Systematic Review and Best Evidence Synthesis." Diagnostics 12, no. 3 (March 11, 2022): 684. http://dx.doi.org/10.3390/diagnostics12030684.
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Background: Hip arthroplasty (HA) is the most common intervention for joint replacement, but there is no consensus in the literature on the real influence of this procedure on balance, or on what factors in the pre-operative, surgical, and post-operative stages may affect it. Purpose: To synthesize the evidence on how Hip Arthroplasty (HA) affects balance, identifying pre-operative, surgical, and postoperative risk factors that may impair balance in HA patients, with the aim to improve patients’ management strategies. Methods: A literature search was performed on PubMed, PeDRO, and Cochrane Collaboration on 25 May 2021. Inclusion criteria: clinical report of any level of evidence; written in English; with no time limitation; about balance changes in hip osteoarthritis (OA) patients undergoing HA and related factors. Results: 27 papers (391 patients) were included. Overall, the evidence suggested that balance is impaired immediately after surgery and, 4–12 months after surgery, it becomes better than preoperatively, although without reaching the level of healthy subjects. A strong level of evidence was found for hip resurfacing resulting in better balance restoration than total HA (THA), and for strength and ROM exercises after surgery positively influencing balance. Conclusion: Both the surgical technique and the post-operative protocols are key factors influencing balance; thus, they should be carefully evaluated when managing hip OA in patients undergoing HA. Moreover, balance at 4–12 months after surgery is better than preoperatively, although without reaching the level of the healthy population. Attention should be paid in the early post-operative phase, when balance may be impaired in patients undergoing HA.
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Kolanowska-Groma, Aleksandra, Marek Synder, Marcin Sibiński, and Stanisław Kłosiński. "Prognosis for Peripheral Nerve Injuries after Hip Joint Arthroplasty." Ortopedia Traumatologia Rehabilitacja 22, no. 5 (October 31, 2020): 323–32. http://dx.doi.org/10.5604/01.3001.0014.4215.
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Background. Peripheral nerve damage is a rare complication of hip replacement surgery that severely impairs the therapeutic outcome. The aim of the present study was to determine the time needed for nerve recovery and restoration of activity following iatrogenic damage during a primary or revision hip arthroplasty from an anterolateral approach and its relationship with the severity of damage. Materials and methods. A prospectively collected database of 1107 patients treated with primary arthroplasty and 303 patients following revision arthroplasty (mean age 63 years, range 53 to 72 years) was analysed. This included 15 cases of palsy of the peroneal branch of the sciatic nerve and 7 of the femoral nerve. The mean follow-up was 3.6 years (minimum two years). Results. The following risk factors were identified: dysplastic osteoarthritis, limb elongation, revision arthroplasty, female sex and post-traumatic osteoarthritis. All five patients demonstrating light palsy (Lovett score 3-5), and 9 out of the 17 with severe palsy (Lovett score 0-2) achieved full recovery. Of all patients, 63.6% regained nerve function after 4 weeks to 24 months (mean 17 months), with nine demonstrating complete recovery and five partial. Also, 66.6% patients regained femoral nerve function and 61.5%, sciatic nerve function. Conclusion. 1. The femoral nerve and the peroneal branch of the sciatic nerve demonstrate a similar pattern of functional recovery following damage. 2. All patients recovered from light palsy, and almost 2/3 of cases of severe palsy demonstrated partial or complete recovery. 3. Female sex is a significant risk factor.
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Roebke, Austin J., Garrhett G. Via, Joshua S. Everhart, Maria A. Munsch, Kanu S. Goyal, Andrew H. Glassman, and Mengnai Li. "Inpatient and outpatient opioid requirements after total joint replacement are strongly influenced by patient and surgical factors." Bone & Joint Open 1, no. 7 (July 1, 2020): 398–404. http://dx.doi.org/10.1302/2046-3758.17.bjo-2020-0025.r1.
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Aims Currently, there is no single, comprehensive national guideline for analgesic strategies for total joint replacement. We compared inpatient and outpatient opioid requirements following total hip arthroplasty (THA) versus total knee arthroplasty (TKA) in order to determine risk factors for increased inpatient and outpatient opioid requirements following total hip or knee arthroplasty. Methods Outcomes after 92 primary total knee (n = 49) and hip (n = 43) arthroplasties were analyzed. Patients with repeat surgery within 90 days were excluded. Opioid use was recorded while inpatient and 90 days postoperatively. Outcomes included total opioid use, refills, use beyond 90 days, and unplanned clinical encounters for uncontrolled pain. Multivariate modelling determined the effect of surgery, regional nerve block (RNB) or neuraxial anesthesia (NA), and non-opioid medications after adjusting for demographics, ength of stay, and baseline opioid use. Results TKAs had higher daily inpatient opioid use than THAs (in 5 mg oxycodone pill equivalents: median 12.0 vs 7.0; p < 0.001), and greater 90 day use (median 224.0 vs 100.5; p < 0.001). Opioid refills were more likely in TKA (84% vs 33%; p < 0.001). Patient who underwent TKA had higher independent risk of opioid use beyond 90 days than THA (adjusted OR 7.64; 95% SE 1.23 to 47.5; p = 0.01). Inpatient opioid use 24 hours before discharge was the strongest independent predictor of 90-day opioid use (p < 0.001). Surgical procedure, demographics, and baseline opioid use have greater influence on in/outpatient opioid demand than RNB, NA, or non-opioid analgesics. Conclusion Opioid use following TKA and THA is most strongly predicted by surgical and patient factors. TKA was associated with higher postoperative opioid requirements than THA. RNB and NA did not diminish total inpatient or 90-day postoperative opioid consumption. The use of acetaminophen, gabapentin, or NSAIDs did not significantly alter inpatient opioid requirements. Cite this article: Bone Joint Open 2020;1-7:398–404.
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Roebke, Austin J., Garrhett G. Via, Joshua S. Everhart, Maria A. Munsch, Kanu S. Goyal, Andrew H. Glassman, and Mengnai Li. "Inpatient and outpatient opioid requirements after total joint replacement are strongly influenced by patient and surgical factors." Bone & Joint Open 1, no. 7 (July 1, 2020): 398–404. http://dx.doi.org/10.1302/2633-1462.17.bjo-2020-0025.r1.
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Aims Currently, there is no single, comprehensive national guideline for analgesic strategies for total joint replacement. We compared inpatient and outpatient opioid requirements following total hip arthroplasty (THA) versus total knee arthroplasty (TKA) in order to determine risk factors for increased inpatient and outpatient opioid requirements following total hip or knee arthroplasty. Methods Outcomes after 92 primary total knee (n = 49) and hip (n = 43) arthroplasties were analyzed. Patients with repeat surgery within 90 days were excluded. Opioid use was recorded while inpatient and 90 days postoperatively. Outcomes included total opioid use, refills, use beyond 90 days, and unplanned clinical encounters for uncontrolled pain. Multivariate modelling determined the effect of surgery, regional nerve block (RNB) or neuraxial anesthesia (NA), and non-opioid medications after adjusting for demographics, ength of stay, and baseline opioid use. Results TKAs had higher daily inpatient opioid use than THAs (in 5 mg oxycodone pill equivalents: median 12.0 vs 7.0; p < 0.001), and greater 90 day use (median 224.0 vs 100.5; p < 0.001). Opioid refills were more likely in TKA (84% vs 33%; p < 0.001). Patient who underwent TKA had higher independent risk of opioid use beyond 90 days than THA (adjusted OR 7.64; 95% SE 1.23 to 47.5; p = 0.01). Inpatient opioid use 24 hours before discharge was the strongest independent predictor of 90-day opioid use (p < 0.001). Surgical procedure, demographics, and baseline opioid use have greater influence on in/outpatient opioid demand than RNB, NA, or non-opioid analgesics. Conclusion Opioid use following TKA and THA is most strongly predicted by surgical and patient factors. TKA was associated with higher postoperative opioid requirements than THA. RNB and NA did not diminish total inpatient or 90-day postoperative opioid consumption. The use of acetaminophen, gabapentin, or NSAIDs did not significantly alter inpatient opioid requirements. Cite this article: Bone Joint Open 2020;1-7:398–404.
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Memtsoudis, Stavros, Crispiana Cozowicz, Nicole Zubizarreta, Sarah M. Weinstein, Jiabin Liu, David H. Kim, Lazaros Poultsides, Marc Moritz Berger, Madhu Mazumdar, and Jashvant Poeran. "Risk factors for postoperative delirium in patients undergoing lower extremity joint arthroplasty: a retrospective population-based cohort study." Regional Anesthesia & Pain Medicine 44, no. 10 (July 12, 2019): 934–43. http://dx.doi.org/10.1136/rapm-2019-100700.
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BackgroundWith an ageing population, the demand for joint arthroplasties and the burden of postoperative delirium is likely to increase. Given the lack of large-scale data, we investigated associations between perioperative risk factors and postoperative delirium in arthroplasty surgery.MethodsThis retrospective population-based cohort study, utilized national claims data from the all-payer Premier Healthcare database containing detailed billing information from >25% nationwide hospitalizations. Patients undergoing elective total hip/knee arthroplasty surgery (2006–2016) were included.The primary outcome was postoperative delirium, while potential risk factors included age, gender, race, insurance type, and modifiable exposures including anesthesia type, opioid prescription dose (low/medium/high), benzodiazepines, meperidine, non-benzodiazepine hypnotics, ketamine, corticosteroids, and gabapentinoids.ResultsAmong 1 694 795 patients’ postoperative delirium was seen in 2.6% (14 785/564 226) of hip and 2.9% (32 384/1 130 569) of knee arthroplasties. Multivariable models revealed that the utilization of long acting (OR 2.10 CI 1.82 to 2.42), combined long/short acting benzodiazepines (OR 1.74 CI 1.56 to 1.94), and gabapentinoids (OR 1.26 CI 1.16 to 1.36) was associated with increased odds of postoperative delirium. Lower odds of postoperative delirium were seen for neuraxial versus general anesthesia (OR 0.81 CI 0.70 to 0.93) and with the utilization of non-steroidal anti-inflammatory drugs (OR 0.85 CI 0.79 to 0.91) as well as cyclooxygenase-2 inhibitors (OR 0.82 CI 0.77 to 0.89). Age-stratified analysis revealed lower odds with high versus low opioid dose (OR 0.86 CI 0.76 to 0.98) in patients >65 years. Findings were consistent between hip and knee arthroplasties.ConclusionsIn this large national cohort, we identified various modifiable risk factors (including anesthesia type and pharmaceutical agents) for postoperative delirium, demonstrating possible prevention pathways.
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Walker, N. M., T. Bateson, P. Reavley, and D. Prakash. "Fatal Fat Embolism following Femoral Head Resection in Total Hip Arthroplasty." HIP International 18, no. 4 (October 2008): 332–34. http://dx.doi.org/10.1177/112070000801800412.
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We report a rare complication during primary total hip arthroplasty. A fatal fat pulmonary embolism immediately followed removal of the femoral head, prior to further preparation of the acetabulum or femoral shaft. Fat embolism syndrome is a well-known complication during total joint arthroplasty, usually attributed to preparation of the femoral shaft, particularly intramedullary reaming and insertion of the prosthesis. These risk factors have previously been identified in the literature. We believe that this case highlights the need for further research to establish the intramedullary pressures during the processes of dislocation and resection of the femoral neck and the attendant risk.
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Aguilera-Bohórquez, Bernardo, Salvador Ramirez, Erika Cantor, Miguel Sanchez, Miguel Brugiatti, Orlando Cardozo, and Mauricio Pachón-Vásquez. "Intra-abdominal Fluid Extravasation: Is Endoscopic Deep Gluteal Space Exploration a Risk Factor?" Orthopaedic Journal of Sports Medicine 8, no. 8 (August 1, 2020): 232596712094095. http://dx.doi.org/10.1177/2325967120940958.
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Background: The extravasation of fluid into the intra-abdominal space is recognized as a possible complication of hip arthroscopic surgery/endoscopy. The exposure of anatomic areas to elevated pump pressures and high volumes of irrigation fluid increases the risk of fluid leakage into anatomic spaces around the hip joint, especially to the abdomen and pelvis. Purpose: To estimate the incidence and risk factors related to intra-abdominal fluid extravasation (IAFE) after hip endoscopy or arthroscopic surgery. Study Design: Cohort study; Level of evidence, 2. Methods: A prospective study was carried out between June 2017 and June 2018. A total of 106 hip procedures (endoscopy or arthroscopic surgery) performed for extra- or intra-articular abnormalities were included. Before and after surgery, in the operating room, ultrasound was performed by a trained anesthesiologist to detect IAFE. The hepatorenal (Morison pouch), splenorenal, retroaortic, suprapubic (longitudinal and transverse), and pleural spaces were examined. Patients were monitored for 3 hours after surgery to assess for abdominal pain. The data collected included maximum pump pressure, duration and volume of irrigation fluid (Ringer lactate), total surgical time, and traction time. Results: The incidence of IAFE was 31.1% (33/106; 95% CI, 23.1%-40.5%). The frequency of IAFE was 52.9% (9/17) in cases with isolated extra-articular abnormalities and 15.9% (7/44) in cases with isolated femoroacetabular impingement; in cases with both extra- and intra-articular abnormalities, the frequency was 37.8% (17/45). An intervention in the subgluteal space was identified as a risk factor for IAFE (odds ratio, 3.62 [95% CI, 1.47-8.85]). There was no statistically significant difference between groups (with vs without IAFE) regarding total surgical time, maximum pump pressure, or fluid volume. Postoperative abdominal pain was found in 36.4% (n = 12) of cases with IAFE compared with 2.7% (n = 2) of cases without extravasation ( P < .001). No patient with IAFE developed abdominal compartment syndrome. Conclusion: IAFE was a frequent finding after hip arthroscopic surgery/endoscopy in patients with extra-articular abnormalities. Exploration of the subgluteal space may increase the risk of IAFE. Pain and abdominal distension during the immediate postoperative period were early warning signs for IAFE. These results reinforce the need for careful intraoperative and postoperative monitoring by the surgeon and anesthesiologist to identify and avoid complications related to IAFE.
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Isaksen, Kjetil F., Elin K. Roscher, Kjetil S. Iversen, Ingrid Eitzen, John Clarke-Jenssen, Lars Nordsletten, and Jan E. Madsen. "Preoperative incipient osteoarthritis predicts failure after periacetabular osteotomy: 69 hips operated through the anterior intrapelvic approach." HIP International 29, no. 5 (October 16, 2018): 516–26. http://dx.doi.org/10.1177/1120700018804786.
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Background: Untreated developmental hip dysplasia may result in pain, loss of function and is a common cause of osteoarthritis (OA). The periacetabular osteotomy (PAO) was developed to relieve symptoms and postpone further degeneration of the hip. We aimed to assess preoperative clinical and radiographic prognostic factors and evaluate survivorship of PAO after medium-term follow-up of 7.4 (2–15) years. Methods: 59 patients (69 hips) operated with a PAO through an anterior intrapelvic approach from 1999 to 2011 were retrospectively identified. The patients were evaluated radiographically and clinically with Harris Hip Score, Western Ontario and McMaster Universities Osteoarthritis Index and 15D quality of life questionnaires. Survival analyses identified native hip joint survival predictors. Results: 9 hips (9 patients) were converted to a total hip arthroplasty (THA). Of the 50 remaining patients (60 hips), 44 patients (54 hips) were examined at medium-term follow-up. 3 patients were lost to follow-up or declined participation and 3 were interviewed by telephone. Patient age at time of surgery was 32 (14–44) years. Survival analyses showed 84.3% (95% confidence interval [CI], 68.7–92.5%) survival of the native hip at 8 years follow-up (number at risk 32) (worst case scenario 80% survival at 8 years, 95% CI, 63.9–89.2%, number at risk 32). Cox regression with presence of preoperative OA (Tönnis ⩾1), showed a crude hazard ratio for conversion to THA with preoperative OA of 13.73, p < 0.001. Conclusions: Periacetabular osteotomy through the anterior intrapelvic approach can be performed safely and with satisfactory results at medium-term follow-up. The presence of preoperative incipient OA (Tönnis ⩾1) is the most important predictor for poor hip joint survival.
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Grammatico-Guillon, Leslie, Sabine Baron, Philippe Rosset, Christophe Gaborit, Louis Bernard, Emmanuel Rusch, and Pascal Astagneau. "Surgical Site Infection After Primary Hip and Knee Arthroplasty: A Cohort Study Using a Hospital Database." Infection Control & Hospital Epidemiology 36, no. 10 (July 8, 2015): 1198–207. http://dx.doi.org/10.1017/ice.2015.148.
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BACKGROUNDHip or knee arthroplasty infection (HKAI) leads to heavy medical consequences even if rare.OBJECTIVETo assess the routine use of a hospital discharge detection algorithm of prosthetic joint infection as a novel additional tool for surveillance.METHODSA historic 5-year cohort study was built using a hospital database of people undergoing a first hip or knee arthroplasty in 1 French region (2.5 million inhabitants, 39 private and public hospitals): 32,678 patients with arthroplasty code plus corresponding prosthetic material code were tagged. HKAI occurrence was then tracked in the follow-up on the basis of a previously validated algorithm using International Statistical Classification of Disease, Tenth Revision, codes as well as the surgical procedures coded. HKAI density incidence was estimated during the follow-up (up to 4 years after surgery); risk factors were analyzed using Cox regression.RESULTSA total of 604 HKAI patients were identified: 1-year HKAI incidence was1.31%, and density incidence was 2.2/100 person-years in hip and 2.5/100 person-years in knee. HKAI occurred within the first 30 days after surgery for 30% but more than 1 year after replacement for 29%. Patients aged 75 years or older, male, or having liver diseases, alcohol abuse, or ulcer sore had higher risk of infection. The inpatient case fatality in HKAI patients was 11.4%.CONCLUSIONSThe hospital database method used to measure occurrence and risk factors of prosthetic joint infection helped to survey HKAI and could optimize healthcare delivery.Infect Control Hosp Epidemiol 2015;36(10):1198–1207
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Almeida, Richard Peter, Lipalo Mokete, Nkhodiseni Sikhauli, Allan Roy Sekeitto, and Jurek Pietrzak. "The draining surgical wound post total hip and knee arthroplasty: what are my options? A narrative review." EFORT Open Reviews 6, no. 10 (October 2021): 872–80. http://dx.doi.org/10.1302/2058-5241.6.200054.
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Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are successful orthopaedic procedures with an ever-increasing demand annually worldwide, and persistent wound drainage (PWD) is a well-known complication following these procedures. Despite many definitions for PWD having been proposed, a validated description remains elusive. PWD is a risk factor for periprosthetic joint infection (PJI). PJI is a devastating complication of THA and TKA, and a leading cause of revision surgery with dramatic morbidity and mortality and a significant burden on health socioeconomics. Prevention of PJI has become an essential focus in THA and TKA. Understanding the pathophysiology, risk factors and subsequent management of PWD may aid in decreasing the rate of PJI. Risk factors of PWD can be divided into modifiable and non-modifiable patient risk factors, pharmacological and surgical risk factors. No gold standard treatment protocol to address PWD exists; however, non-operative options progressing to surgical interventions have been described. The aim of this study was to review the current literature regarding PWD and consolidate the risk factors and management strategies available. Cite this article: EFORT Open Rev 2021;6:872-880. DOI: 10.1302/2058-5241.6.200054
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Sharda, Anish V., and Ken A. Bauer. "Aspirin Thromboprophylaxis in Joint Replacement Surgery." Blood 130, Suppl_1 (December 7, 2017): 702. http://dx.doi.org/10.1182/blood.v130.suppl_1.702.702.
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Introduction. Total knee replacement (TKR) and total hip replacement (THA) surgeries have historically been felt to carry a high risk of post-operative venous thromboembolism (VTE) events thereby warranting anticoagulant prophylaxis. This risk however was based on composite endpoints in which asymptomatic DVT on venography, as opposed to symptomatic VTE or VTE-related mortality, constituted the majority of the events. Furthermore, current day orthopedic practices have likely led to a reduction in risk of VTE, thought to be 3-5% in the absence of prophylaxis. While the American College of Chest Physicians (ACCP) guidelines recommend the use of an anticoagulant for prophylaxis for all patients undergoing TKR and THR over aspirin, American Academy of Orthopaedic Surgeons (AAOS) guidelines classify patients without a prior history of VTE, and those not meeting their high risk criteria (significant cardiovascular disease; BMI > 40; smoking + DM + BMI > 35; and recent cancer) as low-risk; aspirin (325 mg twice daily) is a recommended alternative for post-operative VTE prophylaxis in these patients. As a result, many orthopedic surgeons in the US use aspirin for patients without major risk factors for VTE other than the surgery itself, accounting for over 40% joint replacement surgery cases in the US. The risk of symptomatic VTE in this patient population outside of small and primarily retrospective studies remains unknown. We conducted a prospective cohort study of patients receiving aspirin thromboprophylaxis following TKR and THR surgery at a large orthopedic specialty hospital to assess the risk of clinically symptomatic VTE and bleeding events. This is a preliminary analysis of planned total accrual of 500 subjects (assuming 2% VTE event rate in aspirin-treated patients, as compared to 1% in anticoagulant-treated, with alpha and beta error levels of 5% and 50%, respectively, and accounting for attrition rate of at least 10%). Methods. All TKR and THR patients prescribed aspirin for VTE prophylaxis by the surgical team and not on any anticoagulant medications were eligible for the study. Study subjects were identified and consented post-operatively prior to their hospital discharge. Enrolled subjects were followed for symptomatic VTE and bleeding events during their hospitalization, and then contacted at 30 and 90 days postoperatively for a telephone survey. Symptomatic VTE and bleeding events were captured using a questionnaire and outside records obtained to confirm VTE or major bleeding events. Three-month risk of symptomatic VTE and major bleeding events associated with aspirin thromboprophylaxis were estimated. Results. A total of 300 patients, 199 TKR and 101 THR, have been enrolled in this ongoing study so far. Table 1 shows the baseline characteristics of the patients. A total of 6 symptomatic VTE (4 pulmonary emboli, 1 proximal deep vein thrombosis (DVT) and 1 isolated-distal DVT) occurred during the follow up period. (3-month post-op VTE event rate of 2%). 3 events were diagnosed during hospitalization, whereas the remaining 3 occurred following hospital discharge (within 7-10 days). Bruising was a common side effect affecting nearly 3% of the patients, but major bleeding events were rare, only 1 major upper gastrointestinal bleeding, giving a 3-month risk of 0.33%. There were no surgical bleeds reported. Conclusions. In this single-center prospective cohort study of TKR and THR patients considered to be at lower risk for VTE, the use of aspirin for thromboprophylaxis was associated with a 2% symptomatic VTE event rate over three months of follow up with minimal bleeding risk. This result, together with those of the EPCATII study from Canada showing that low-dose aspirin was as effective (~0.7% event rate) following 5 days of rivaroxaban following TKR and THR in lower risk patients, argues for a large randomized trial evaluating aspirin as monotherapy for VTE prophylaxis in such patients. Disclosures No relevant conflicts of interest to declare.
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Jaffer, Amir, Jason Hurbanek, Nariman Morra, and Daniel Brotman. "Warfarin prophylaxis and venous thromboembolism in the first 5 days following hip and knee arthroplasty." Thrombosis and Haemostasis 92, no. 11 (2004): 1012–17. http://dx.doi.org/10.1160/th04-04-0204.
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SummaryMany orthopaedic surgeons use warfarin to prevent venous thromboembolism (VTE) following hip or knee arthroplasty. Since warfarin’s antithrombotic effects are delayed, we hypothesized that early VTE (occurring within 5 days post-operatively) would be more common in arthroplasty patients receiving warfarin monotherapy compared to those receiving enoxaparin. We performed a secondary analysis of a case-control study examining risk factors for post-operative thrombosis in postmenopausal women. We defined cases as patients who were diagnosed with thrombosis within 5 days of surgery. Controls without thrombosis were matched with cases by age, surgeon, year of surgery and surgical joint. 84 women with early post-operative thrombosis (cases) were matched with 206 controls. 18 cases (21.4%) had been prescribed warfarin monotherapy, compared with 7 controls (3.4%). 58 (69.1%) cases and 195 (94.7%) controls had been prescribed subcutaneous enoxaparin 30 mg twice daily, starting 12-24 hours after surgery. The odds ratio for any early thrombosis in patients receiving warfarin as opposed to enoxaparin 30 mg twice daily was 8.6 (p<0.0001). For proximal thrombosis, the odds ratio was 11.3 (p<0.0001). Multivariate analysis did not alter these findings. Warfarin’s delayed antithrombotic effects may not provide adequateVTE prophylaxis in the immediate post-operative setting. We suggest caution in employing warfarin monotherapy following joint arthroplasty.
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Terai, Hidetomi, Yusuke Hori, Shinji Takahashi, Koji Tamai, Masayoshi Iwamae, Masatoshi Hoshino, Shoichiro Ohyama, Akito Yabu, and Hiroaki Nakamura. "Impact of the COVID-19 pandemic on the development of locomotive syndrome." Journal of Orthopaedic Surgery 29, no. 3 (September 2021): 230949902110609. http://dx.doi.org/10.1177/23094990211060967.
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Background The coronavirus disease 2019 (COVID-19) pandemic has affected people in various ways, including restricting their mobility and depriving them of exercise opportunities. Such circumstances can trigger locomotor deterioration and impairment, which is known as locomotive syndrome. The purpose of this study was to investigate the incidence of locomotive syndrome in the pandemic and to identify its risk factors. Methods: This was a multicenter questionnaire survey performed between 1 November 2020 and 31 December 2020 in Japan. Patients who visited the orthopedics clinic were asked to answer a questionnaire about their symptoms, exercise habits, and locomotor function at two time points, namely, pre-pandemic and post-second wave (current). The incidence of locomotive syndrome in the COVID-19 pandemic was investigated. Additionally, multiple logistic regression analysis was used to identify the risk factors for developing locomotive syndrome during the pandemic. Results: A total of 2829 patients were enrolled in this study (average age: 61.1 ± 17.1 years; 1532 women). The prevalence of locomotive syndrome was 30% pre-pandemic, which increased significantly to 50% intra-pandemic. Among the patients with no symptoms of locomotive syndrome, 30% developed it in the wake of the pandemic. In the multinomial logistic regression analysis, older age, deteriorated or newly occurring symptoms of musculoskeletal disorders, complaints about the spine or hip/knee joints, and no or decreased exercise habits were independent risk factors for developing locomotive syndrome. Conclusions: The prevalence of locomotive syndrome in patients with musculoskeletal disorders has increased during the COVID-19 pandemic. In addition to age, locomotor symptoms, especially spine or hip/knee joint complaints, and exercise habits were associated with the development of locomotive syndrome. Although the control of infection is a priority, the treatment of musculoskeletal disorders and ensuring exercise habits are also essential issues to address during a pandemic such as COVID-19.