With the rising utilization of total joint arthroplasty, the role of simultaneous-bilateral surgery has expanding impact. The purpose of this study is to examine the risk of perioperative complications for this approach in total knee arthroplasty to inform shared decision making. We used nation-wide linked discharge data from the Hospital Cost and Utilization Project from 2005–2014 comparing outcomes of simultaneous-bilateral and staged-bilateral total knee arthroplasties (TKAs). Hierarchical logistic regression analysis was used to compare mortality within 30 days, 90 days and 1 year, perioperative risks within 30–60 days, and infection and mechanical complications within 1 year.Introduction
Methods
Increasingly, patients with bilateral hip arthritis wish to undergo staged total hip arthroplasty. With the rise in demand for arthroplasty perioperative risk assessment and counseling is critical for shared decision making; however, it is unknown if complications that occur after a unilateral hip arthroplasty predict complications following surgery of the contralateral hip. We used nation-wide linked discharge data from the Hospital Cost and Utilization Project from 2005–2014 to analyze the incidence and recurrence of complications following the first and second stage operations in staged bilateral total hip arthroplasty (BTHAs). Complications included perioperative risks within 30–60 days, and infection and mechanical complications within one year. Conditional probabilities and odds ratios were calculated to determine whether experiencing a complication after the first stage of surgery increased the risk of developing the same complication after the second stage.Introduction
Methods
Metal on metal total hip resurfacing is a bone-conserving reconstructive option for patients with advanced articular damage. The optimal indications for this procedure are being defined by recent international experience. This study evaluates the minimum two-year results of resurfacing arthroplasty compared to conventional hip replacement in young patients with a variety of diagnoses. Resurfacing arthroplasty was performed in 180 patients over 5 years as part of two investigational device trials. The focus of this analysis was 57 hips (52 patients, mean age 47.3 years) performed between December 2000, and November 2003, by one surgeon at a single center. Seventeen percent of the resurfacing cases were performed for treatment of osteonecrosis. These patients, representing the initial experience of the operating surgeon, were followed prospectively for a minimum of two years (mean, 2.95 years, range, 2–4 years) and compared to 93 cementless primary total hip arthroplasties (84 patients, mean age 57.1 years) with metal on polyethylene bearings over the same time period using regression analysis to control for age, gender, and preoperative function. After controlling for age and preoperative differences, the total Harris hip score (HHS), function score, and pain score were not significantly different between the two groups. However, the activity score (p=0.03) and ROM score (p<
0.001) were significantly greater in the resurfacing group. The complication rates were similar between the two groups (14.0% THA vs. 5.3% resurfacing, p=ns). There were no femoral side failures among the osteonecrosis cases treated with hip resurfacing. Both the total hip replacement and metal on metal resurfacing groups showed marked improvement in HHS, pain, activity, and range of motion in a young and active patient cohort. The number of early complications was not greater in the resurfacing group compared to the total hip replacement group.
Patient postoperative outcome can be accurately predicted by the patient’s preoperative HHS or WOMAC score. Prospective, cohort studies of one hundred and seventy-five THAs. SF-36, WOMAC and Harris Hip Score (HHS)questionnaires were used to determine pre-operative and two year final outcome. Student’s t-test, 95% confidence intervals, receiver operator characteristic curves, simple regression analysis and probability were measured. Patients with a HHS = sixty-five pre-operatively had a 100% probability of having an excellent result postoperatively. A preoperative HHS value of thirty-four, and preoperative WOMAC (physical function) value of fifty were the best cutoff points to attain a significantly better postoperative functional outcome. Total hip arthroplasty (THA) has been well documented to enhance patient function, but patient outcome is dependant on preoperative statuts. The exact timing of surgery to optimize patient outcome after THA remains unknown. This study determines the ideal timing for surgery to obtain the best possible functional outcome. Prospective, multicenter, cohort studies of one hundred and seventy-five identical, cemented THAs. General health (SF-36) and disease specific (WOMAC and Harris Hip Score(HHS)) questionnaires were used to determine preoperative and two year final outcome. Student’s t-test, 95% confidence intervals, receiver operator characteristic curves, simple regression analysis and probabilty were measured. All functional scores were improved significantly postoperatively (p<
0.001). Patients with a HHS = sixtyfive preoperatively had a 100% probability of having an excellent result postoperatively. A preoperative HHS value of thirty-four, and preoperative WOMAC (physical function) value of fifty were the best cutoff points to attain a significantly better postoperative functional outcome. Patient postoperative outcome can be accurately predicted by the patient’s preoperative HHS or WOMAC score. Optimization of surgical timing, by prioritizing wait lists or deciding to treat the arthritis operatively, based on these preoperative score guidelines will help ensure an excellent outcome post THA.
