Academic literature on the topic 'Total hip replacement Complications Risk assessment Statistical methods'

Introduction. Total hip replacement is an operative treatment method for end-stage osteoarthritis, considered the most effective nowadays. One of the typical complications after the procedure is heterotopic ossification which may influence patient posture stability and increase the risk of falls. Aim. The study aimed to assess whether patients developing heterotopic ossifications after total hip replacement have a higher risk of falls in comparison to the matched-cohort group without them. Materials and methods. 46 out of 312 patients undergoing a total hip replacement in 2020 who developed heterotopic ossifications were observed. For these patients, a propensity score based on age, sex, and BMI was generated, and a matched-cohort control group consisting of 39 patients was selected. Each patient was operated on via an anterolateral approach, and an uncemented total hip prosthesis was implanted. Patients from both cohorts underwent postoperative radiological and biomechanical assessment and fulfilled WOMA C and Oxford questionnaires pre-and postoperatively. Statistical analyses of the results were performed. Results. There were statistically significant differences between cohorts in the postural stability test (4.9±1.1 vs 2.0±1.0 p<0.05), antero-posterior stability index (3.6±1.2 vs 1.6±0.9, p<0.05), medio-lateral stability index (3.0±1.3 vs 1.0±0.7, p<0.05) and risk of fall test (9.8±1.0 vs 7.8±1.0, p<0.05). No statistically significant differences were observed in the WOMA C and Oxford questionnaires. Conclusions. Our study proved that heterotopic ossifications, which appear in hip abductor muscles, could have an impact on balance and the risk of falls in patients after total hip replacement. In the elderly population, this can result in serious consequences such as a periprosthetic fracture or head trauma after total hip replacement.

Background: Vascular thromboembolism is one of the major concerns of orthopedic surgeons after hip or knee replacement surgery. Although many thromboprophylactic drugs have been introduced, there is still no consensus over their efficacy and safety. Therefore, this study aimed to compare the efficacy and safety of oral rivaroxaban and aspirin administration and enoxaparin injections in patients undergoing knee or hip replacement. Objectives: Determination and comparison of the side effect and efficacy of Rivaroxaban and Enoxaparin after total hip or knee arthroplasty. Methods: A total of 231 patients undergoing knee or hip replacement surgery were included in the study. Of them, 31 patients were excluded due to missing the follow-up. Of the remaining 200 patients, 42 low-risk and 158 moderate- to high-risk patients were identified, according to Caprini risk assessment model. Then, they were divided into three groups: aspirin (42 patients), enoxaparin (78 patients), and rivaroxaban (80 patients). Severe hemorrhage (hemoglobin reduction of more than 2 g/dL or requiring blood transfusion) was assessed after the first dose of medication until discharge through daily hemoglobin testing. Frequency of other side effects such as wound complications (ecchymosis, hematoma, and wound infection) and gastrointestinal or skin problems was recorded and compared by daily examination during the hospital stay and then in the future visits to the clinic up to 6 months in each group. Follow up visits were performed at weeks 6, 12, and 24. Results: No cases of deep vein thrombosis or pulmonary thromboembolism were observed in any of the study groups. There was no significant difference between the two groups in the number of major bleeding cases (P=0.39). Ecchymosis around the wound was significantly higher in the rivaroxaban group than in the enoxaparin group (33.8% vs. 23%). However, this difference was not statistically significant (P=0.06). Conclusion: The efficacy and safety of rivaroxaban and enoxaparin drugs are comparable. Although ecchymosis was seen after using rivaroxaban rather than enoxaparin, rivaroxaban is orally administered and costs less for the patient and the health system. So, its use as a thromboprophylactic drug of choice following hip and knee arthroplasty surgery is still recommended.

Abstract Abstract 169 Introduction: Venous thromboembolism (VTE) is a common complication after hip or knee replacement and is associated with significant morbidity and mortality. Anticoagulants reduce the risk of these complications, but can also result in increased bleeding, thus requiring an assessment of benefit–risk. Patients and Methods: To obtain more precise estimates of treatment effects on low frequency events, data were pooled from 4 phase 3 randomized clinical trials (RECORD1–4) of rivaroxaban vs enoxaparin regimens (or enoxaparin/placebo combination in 1 study) for the prevention of deep vein thrombosis (DVT) and pulmonary embolism (PE) in total hip and knee replacement. Although the studies were designed to answer slightly different questions and differed in treatment duration and comparator dose, pooling was supported by similar study designs, identical endpoints, identical event ascertainment methods, and the same independent central blinded adjudication committees. Benefit–risk was assessed by comparing the excess number of outcome events for benefits vs that for harms (‘risks'), occurring over the treatment period. Excess number of events was defined as the number of events in a hypothetical population of 10,000 patients treated with enoxaparin minus the number of events in such a population treated with rivaroxaban. A positive value indicates that fewer events occur in the population treated with rivaroxaban. The analysis was undertaken for several clinically comparable pairs of composite benefit and harm outcomes: total VTE (any DVT, non-fatal PE, or death from any cause) vs major and clinically relevant non-major (CRNM) bleeding; major VTE (proximal DVT, non-fatal PE, or VTE-related death) vs major bleeding; and symptomatic VTE/all-cause mortality vs major bleeding. For each pair, pooled Mantel–Haenszel weighted risk differences were used to compute the excess number of benefit and harm events, and the difference between excess numbers of events was used to evaluate net clinical benefit (NCB; Table). In all calculations, benefits and risks were weighted equally. An additional assessment was performed using all treatment-emergent serious adverse events (SAEs) as reported by investigators. Results: Rixaroxaban is associated with statistically significantly fewer total VTE, major VTE, and symptomatic VTE/all-cause mortality events than enoxaparin, whereas enoxaparin is associated with a smaller number of different bleeding events, although no bleeding endpoints, other than the composite of major + CRNM bleeding, were statistically significantly different. In each pairwise comparison, the excess number of bleeding events is less than the excess number of VTE-related events by a factor ranging from 4 to 10 (Table). Enoxaparin was also associated with an excess of 194 treatment-emergent SAEs compared with rivaroxaban out of 10,000 patients. In all cases, there is a positive NCB for rivaroxaban vs enoxaparin with 95% confidence intervals (CIs) excluding 0, suggesting that the benefits of rivaroxaban exceed the risks when compared with enoxaparin. Conclusions: This quantitative benefit–risk approach provides a comparison of interventions in clinically relevant population terms. Using the net clinical benefit approach, for a variety of endpoints defining benefits and harms, the benefit–risk profile for rivaroxaban is consistently improved compared with enoxaparin for patients after elective hip and knee replacement. Disclosures: Levitan: Johnson & Johnson Pharmaceutical Research & Development, L.L.C.: Employment, Equity Ownership. Yuan:Johnson & Johnson Pharmaceutical Research & Development, L.L.C.: Employment, Equity Ownership. Turpie:Johnson & Johnson Pharmaceutical Research & Development, L.L.C.: Consultancy; Bayer Schering Pharma AG: Consultancy, Speakers Bureau; sanofi-aventis: Consultancy; GSK: Consultancy; Astellas: Consultancy; Takeda: Consultancy; Portola: Consultancy. Friedman:Boehringer Ingelheim : Consultancy, Research Funding; Johnson & Johnson : Consultancy; Astellas US: Consultancy, Research Funding; Sanofi-Aventis: Consultancy. Homering:Bayer Schering Pharma AG: Employment. Berlin:Johnson & Johnson Pharmaceutical Research & Development, L.L.C.: Employment, Equity Ownership. Berkowitz:Bayer HealthCare Pharmaceuticals: Employment. DiBattiste:Johnson & Johnson Pharmaceutical Research & Development, L.L.C.: Employment.

<p class="abstract"><strong>Background:</strong> Modern hip replacement has resulted in huge benefit for patients with arthritic hip disease, providing them with reduction of pain, return of function and consequently an improved quality of life. Evaluation of long term outcomes of an operative procedure is important to determine the durability of the procedures like uncemented total revision hip arthroplasty. In the present study, clinical and functional outcome and complications of uncemented total hip arthroplasty in failed primary hemiarthroplasty was assessed.</p><p class="abstract"><strong>Methods:</strong> Patients with failed primary hemiarthroplasty with Unipolar or Bipolar prosthesis (cemented and uncemented) due to aseptic loosening, protrusio causing groin pain, dislocation, breakage of implant leading to loss of function, periprosthetic fracture and acetabular osteolysis were included. During each visit, medical history was taken and physical examination was done. Range of movements (ROM) was recorded. The clinical and functional outcomes were evaluated by Harris Hip Score evaluation. Statistical analysis: Student’s paired t-test was used to find out the significance of difference between pre-operative and post-operative Harris Hip scores.<strong></strong></p><p class="abstract"><strong>Results:</strong> In 7 cases modular series was used for uncemented total hip arthroplasty, of which calcar replacement was done in 4 cases, and in one case constrained liner was placed. The maximum stem size used was 15mm and the minimum stem size 11mm. Stem size 11 was most frequently used. About 30% of the cases presented with pain postoperatively till the last follow-up, of which two cases reported mild pain with no effect on average activities and one case reported with moderate pain with some limitation of ordinary activity or work. The difference between the average pre-operative Harris Hip Score post-operative score was found to be highly significant (p=0.0001).</p><p><strong>Conclusions:</strong> This study has shown excellent results following the uncemented modular total hip arthroplasty in failed primary hemiarthroplasty in terms of pain relief, increased walking distance, and functional capabilities of the patients.</p>

Chronic postoperative pain (POP) is a serious complication of total replacement (TR) of the knee (KJ) and hip (HJ) joints.Objective: to determine the factors associated with POP in patients after TR of KJ or HJ.Patients and methods. The study group consisted of 124 patients with knee osteoarthritis or hip osteoarthritis (age 63.6±9.9 years, 63% women and 37% men) who underwent TR of KJ or HJ. POP was defined as pain ≥40 mm on a numerical rating scale persistent for ≥3 months. Its presence was assessed after 3 and 6 months by telephone survey. Comparison of patients with POP and without it was carried out for a number of factors identified before surgery.Results and discussion. The incidence of POP was 27.4%. There was no difference in the incidence of POP in patients after TR of KJ or HJ: 28.1% and 26.9% (p=0.88). POP was statistically significantly associated with parameters such as higher body mass index (BMI); the intensity of pain at rest; general assessment of impairment; WOMAC index pain, stiffness and overall; severity of symptoms of neuropathic pain (PainDETECT); signs of depression and anxiety (HADS).The risk of POP was significantly higher (p<0.05) with BMI >30 kg/m2 (odds ratio, OR 2.755; 95% confidence interval, CI 1.053–7.206), rest pain ≥40 mm on a visual analog scale (OR 1.349; 95% CI 0.478–3.803), PainDETECT scores ≥13 (OR 3.598; 95% CI 1.048–12.36) and HADS depression ≥8 (OR 2.193; 95% CI 0.745–6.454), presence of ≥2 sources of pain (OR 6.996; 95% CI 2.358–20.756).Conclusion. It was found that the risk of POP after TR of KJ and HJ is higher in patients with overweight, severe preoperative pain, signs of neuropathic pain and depression, as well as in the presence of several sources of pain (except for the affected joint, that was replaced surgically).

Aims Recent improvements in surgical technique and perioperative blood management after total joint replacement (TJR) have decreased rates of transfusion. However, as many surgeons transition to outpatient TJR, obtaining routine postoperative blood tests becomes more challenging. Therefore, we sought to determine if a preoperative outpatient assessment tool that stratifies patients based on numerous medical comorbidities could predict who required postoperative haemoglobin (Hb) measurement. Methods We performed a prospective study of consecutive unilateral primary total knee arthroplasties (TKAs) and total hip arthroplasties (THAs) performed at a single institution. Prospectively collected data included preoperative and postoperative Hb levels, need for blood transfusion, length of hospital stay, and Outpatient Arthroplasty Risk Assessment (OARA) score. Results A total of 504 patients met inclusion criteria. Mean age at time of arthroplasty was 65.3 years (SD 10.2). Of the patients, 216 (42.9%) were THAs and 288 (57.1%) were TKAs. Six patients required a blood transfusion postoperatively (1.19%). Transfusion after surgery was associated with lower postoperative day 1 Hb (median of 8.5 (interquartile range (IQR) 7.9 to 8.6) vs 11.3 (IQR 10.4 to 12.2); p < 0.001), longer length of stay (1 day (IQR 1 to 1) vs 2 days (IQR 2 to 3); p < 0.001), higher OARA score (median of 60.0 (IQR 40 to 75) vs 5.0 (IQR 0-35); p = 0.001), and total hip arthroplasty (p < 0.001). All patients who received a transfusion had an OARA score > 34; however, this did not reach statistical significance as a screening threshold. Conclusion Risk of blood transfusion after primary TJR was uncommon in our series, with an incidence of 1.19%. Transfusion was associated with OARA scores > 60. The OARA score, not American Society of Anesthesiologists grade, reliably identified patients at risk for postoperative blood transfusion. Selective Hb monitoring may result in substantial cost savings in the era of cost containment. Cite this article: Bone Joint J 2021;103-B(1):65–70.

Introduction: The purpose of the present study was (i) to review the long-term outcome of cemented Charnley total hip replacements (THRs) performed by 1 surgeon (GH), 20 to 42 years ago, in patients ≥60 years, using both the Kaplan-Meier (KM) and the cumulative incidence (CI) methods, and (ii) to compare the estimations of the 2 statistical methods. Methods: We evaluated the outcome of 306 consecutive primary cemented THRs that were performed in 265 patients. The final clinical, radiographic assessment and satisfaction of living patients were also included. The survivorship was estimated with the use of KM and CI methods and the relative difference between their estimations was calculated. Results: Living patients’ final clinical results were significantly improved in comparison with respective preoperative ones, and all the acetabular and 91% of femoral components considered as well fixed. 95% of these patients reported satisfaction. The risk of revision at 25 years, with revision for aseptic loosening for 1 or both components as the endpoint, with 21 hips at risk, assessed with KM analysis was 6.9% and with CI approach was 3.9%. The relative difference between KM and CI estimations was increasing during follow-up, reaching up to 76.8% at 25 years. Conclusions: We concluded that fixation of implants with cement in older patients had satisfactory long-term results and can serve as a benchmark with which to compare newer fixation methods (hybrid and uncemented) and materials. However, KM method, in studies that include older population with long-term follow-up, may significantly overestimate the risk of revision and clinicians could consider using besides the cumulative incidence of competing risk method.

Objectives. Patients taking opioids prior to surgery experience prolonged postoperative opioid use, worse clinical outcomes, increased pain, and more postoperative complications. We aimed to compare preoperative opioid users to their opioid naïve counterparts to identify differences in baseline characteristics. Methods. 107 patients presenting for thoracotomy, total knee replacement, total hip replacement, radical mastectomy, and lumpectomy were investigated in a cross-sectional study to characterize the associations between measures of pain, substance use, abuse, addiction, sleep, and psychological measures (depressive symptoms, Posttraumatic Stress Disorder symptoms, somatic fear and anxiety, and fear of pain) with opioid use. Results. Every 9-point increase in the Screener and Opioid Assessment for Patients with Pain-Revised (SOAPP-R) score was associated with 2.37 (95% CI 1.29–4.32) increased odds of preoperative opioid use (p=0.0005). The SOAPP-R score was also associated with 3.02 (95% CI 1.36–6.70) increased odds of illicit preoperative opioid use (p=0.007). Also, every 4-point increase in baseline pain at the future surgical site was associated with 2.85 (95% CI 1.12–7.27) increased odds of legitimate preoperative opioid use (p=0.03). Discussion. Patients presenting with preoperative opioid use have higher SOAPP-R scores potentially indicating an increased risk for opioid misuse after surgery. In addition, legitimate preoperative opioid use is associated with preexisting pain.

Abstract Introduction: Sickle cell disease (SCD) is complicated by widespread tissue and organ damage, including avascular necrosis (AVN) of the bones. Common sites of AVN include the shoulders and hips, which often causes severe pain and limited joint function, leading to surgical treatment. Although common, the prevalence of symptomatic AVN and optimal management for this disease has not been well defined. Furthermore, the overall effect of operative treatment on pain episodes requiring hospitalization is not known. The aim of this study is to retrospectively examine the prevalence of symptomatic AVN in adult SCD patients and assess the effects of surgical therapy. Methods: The Adult Hemoglobinopathy Resource Center at Washington University provides care for adult SCD patients throughout the St. Louis, Missouri metropolitan area. All patients have confirmed SCD (Hgb SS, Hgb SC, Hgb Sβ+, Hgb Sβ0, Hgb SC Harlem, Hgb SOther) and have been seen at least once since 2011 to be included in the study. Patients with new onset or worsening hip or shoulder pain underwent imaging studies and the presence or absence of radiographic evidence of AVN was used to determine the prevalence. The medical record was reviewed to identify patients with orthopedic procedures for AVN. The operative history of individuals with AVN was assessed and data from the post-operative hospital course was collected. The medical record was also reviewed to assess for subsequent hospitalizations and to determine whether the complications were directly related to the surgery or not. Medical record data was collected through June 2014. The surgical procedures were determined by the treating orthopedists and were not prospectively evaluated. Results: From October 2011 to June 2014, 324 patients have been evaluated. Of these patients, the mean age is 36 years (range 18-81); 180 are female (55.6%), and 144 are male (44.4%). The hemoglobinopathies include SS-205, SC-90, Sβ+-21, Sβ0-5, SC Harlem-2, and one unconfirmed genotype of SCD because of longstanding chronic transfusions. Out of the 324 patients, 94 (29%) had clinical and radiographic findings consistent with AVN of the hip(s) and 64 (19.8%) had findings consistent with AVN of the shoulder(s). No statistical difference was detected between genders (p >0.5) or among the genotypes, including between hemoglobin SS and SC (p>0.3). Forty-eight patients underwent 74 operations for AVN including 50 hip and 24 shoulder procedures. For the hip surgeries, these included 44 total hip arthroplasties, 2 hemiarthroplasties, 2 core decompressions and 2 other operative procedures. For the shoulder procedures, there were 11 total shoulder arthroplasties, 4 hemiarthroplasties, 8 core decompressions and 1 other operative treatment. All patients received pre-operative red cell transfusion support. The mean post-operative time in the hospital was 3.6 days (range <1-8) for hip surgery and 2.4 days (range <1-8) for shoulder surgery. Notably, there were thirteen re-hospitalizations within 30 days of surgery but these were all felt to be for pain syndromes not directly related to the surgical site. Fourteen patients were readmitted over the course of their care for joint-related complications resulting in 6 surgical revisions. Three had hemiarthroplasties converted to total arthroplasties, including both patients who originally received hip hemiarthroplasties. Both patients who underwent hip core decompressions later received total hip arthroplasties in those joints, and one patient of a shoulder core decompression also required total joint replacement. With three years of follow up, one patient underwent surgical removal of the prosthesis and insertion of an antibiotic spacer to treat a possible infection. Overall, patients who underwent surgical treatment for AVN had 2.4 hospitalizations per year for either joint related complications or other SCD related issues. Conclusion: SymptomaticAVN of hips and shoulders is a frequently occurring complication for patients with SCD. This data supports the role for joint replacement surgery as an effective treatment to improve joint function with a low risk of complications. However, hospitalizations for other complications of SCD, particularly sickle cell related pain, continue to occur and strategies for preventing AVN remain to be defined. Disclosures No relevant conflicts of interest to declare.

Background: Insulin-treated diabetes patients are at high risk of developing lipohypertrophy, which can negatively impact treatment outcomes. Early detection of lipohypertrophy is crucial to preventing blood glucose fluctuation. Unfortunately, this clinical issue is often overlooked by nurses, causing the development of vascular complications, which leads to an increase in the morbidity and mortality of the type 2 diabetes mellitus population. Objective: This study was conducted to identify lipohypertrophy prevalence and to establish the association between the presence of lipohypertrophy and its associated risk factors, including years on injection, total injection in a day, total insulin unit per day, often change needle, insulin injection site and move to a different area. Methods: This cross-sectional study included 128 patients with type 2 diabetes mellitus who received insulin therapy in an outpatient diabetic clinic. Questionnaires on socio-demographic and lipohypertrophy-associated risk factors were distributed among patients, and lipohypertrophy-assessment was done using a checklist. Descriptive statistics and Pearson Chi-square were used for statistical analysis. Results: The prevalence of lipohypertrophy was 51.6% (95% CI: 42.6, 60.5). Swelling on fatty tissue (46.1%) exhibited the highest percentage of lipohypertrophy features during the assessment. Pearson Chi-Square revealed a significant relationship between the presence of LH and BMI categories (χ2 = 10.059, df = 3, p = 0.018), duration of injection (χ2 = 15.001, df = 3, p = 0.002), frequency of needle replacement (χ2 = 9.525, df = 3, p = 0.023) and rotation of injection site (χ2 = 5.914, df = 1, p = 0.015). Conclusion: The high prevalence of lipohypertrophy indicates a need for a prevention strategy. Thus, nurses should play an important role in educating patients regarding the proper administration of insulin injections and performing a routine lipohypertrophy assessment and health education on the correct method of insulin injection.