We examined patient and surgical factors associated with deep surgical site infection (SSI) following total hip replacement (THR) in a large integrated healthcare system. A retrospective review of a cohort of primary THRs performed between 2001 and 2009 was conducted. Patient characteristics, surgical details, surgeon and hospital volumes, and SSIs were identified using the Kaiser Permanente Total Joint Replacement Registry (TJRR). Proportional-hazard regression models were used to assess risk factors for SSI. The study cohort consisted of 30 491 THRs, of which 17 474 (57%) were performed on women. The mean age of the patients in the whole series was 65.5 years (13 to 97; . sd. 11.8) and the mean body mass index was 29.3 kg/m. 2. (15 to 67; . sd. 5.9). The incidence of SSI was 0.51% (155 of 30 491). Patient factors associated with SSI included female gender, obesity, and American Society of Anesthesiologists (ASA) score ≥ 3. Age, diagnosis, diabetes and race were not associated with SSI. The only surgical factor associated with SSI was a bilateral procedure. Surgeon and hospital volumes, use of antibiotic-laden cement, fixation method, laminar flow, body exhaust suits, surgical approach and fellowship training were not associated with risk of SSI. A comprehensive infection surveillance system, combined with a TJRR, identified patient and surgical factors associated with SSI. Obesity and chronic medical conditions should be addressed prior to THR. The finding of increased SSI risk with bilateral THR requires further investigation

Background. Much effort has been aimed at strategies for patient optimization, perioperative standards of care, and postoperative risk stratification to reduce the incidence of SSI. Examples include, newer dressing modalities, antibiotic-impregnated bone cement, intra-wound powdered antibiotics, as well as novel suture types and techniques, all of which have shown great potential. However, the question remains as to whether these changes in practice have led to lower overall infections over the past few years. Therefore, the purpose of this study was to track the annual rates and trends of: 1) overall; 2) deep; and 3) superficial SSI following total hip arthroplasty (THA) using the most recent data (2012 to 2016) from a large nationwide database. Methods. The National Surgical Quality Improvement Program database was queried for all primary THAs (CPT code 27130) between 2012 and 2016, yielding 122,451 cases. Cases with reported superficial and/or deep SSIs were combined for an overall rate, and then independently analyzed as deep and superficial SSIs. The infection incidence for each year was calculated. After an overall 5-year correlation and trends, univariate analysis was also performed to compare the most recent year, 2016, with each of the preceding 4 years. Furthermore, a comparison of overall and deep SSI incidences from this study were compared to meta-analysis of pooled data from 2001 to 2011. Pearson correlation coefficients and chi-squared tests were used to determine correlation and statistical significance which was maintained at a p-value less than 0.05. Results. Over the 5-year period, 1,154 cases out of 122,451 (0.94% of all cases) were complicated by any SSI. The lowest incidence was in the latest year, 2016 (n=289, 0.81%), while the greatest was in the earliest year, 2012 (n=163, 1.12%). There was a significant inverse correlation between overall SSI rate and year (p<0.01). A 31% decrease in rate was found between 2016 and 2012 (0.81% vs. 1.12%, p<0.01). For deep SSI, the lowest incidence was in the most recent year, 2016 (n=82, 0.23%). The incidence over 5 years was 0.30% (364 out of 122,451 cases). The mean percent decrease in deep SSI incidence over the 5 years was 31%. There was a 49% decrease in deep SSI rate in 2016 compared to 2015 (0.23% vs. 0.38%, p>0.05). Additionally, there was an inverse correlation between deep SSI rate and year of surgery (p>0.05). The lowest superficial SSI incidence occurred in the most recent year, 2016 (n=204, 0.58%), while 2012 had the greatest incidence (n=121, 0.83%). There were a total of 796 cases out of 122,451 over 5 years, an incidence of 0.65%. A 31% decrease was observed between 2016 and 2012 (0.58% vs. 0.83%, p=0.001). There was a statistically significant inverse correlation between superficial SSI rate and year (p<0.01). A meta-analysis evaluating primary THA SSIs from 2001 to 2011 reported an overall SSI incidence of 2.5% (95% confidence interval [Cl], 1.4%-4.4%; P<.001; n=28,883), substantially higher (309%) than the 2016 incidence of 0.81% found in this study. Furthermore, the meta-analysis reported an incidence for deep SSIs to be 0.9% (95% Cl, 0.4%-2.2%; p<.001; n=28,883), also found to be markedly lower than the 2016 incidence noted here (0.23%), marking a 391% difference. Conclusion. The findings from this study suggest that the evolving standards of care have brought about improvements in SSI prevention following THA over time. Deep SSIs, which can pose substantial threats to implant survivorship, have decreased throughout the years. These results highlight the importance of following up-to-date clinical recommendations to reduce surgical site infections and substantially improve patient outcomes

Emerging evidence from different countries around the world is increasingly associating hip and knee replacements performed during the summer months with an increased risk of surgical site infection (SSI). We aimed to synthesise evidence on this phenomenon globally. A systematic review was performed according to PRISMA guidelines using Medline, PubMed, and EMBASE from inception until August 2021 for relevant original articles without language restrictions. Meta-analysis was performed using random effects models to estimate and compare the pooled odds ratio (OR) and the confidence interval (CI) of operations undertaken during the summer season as defined by study authors. Five studies from Canada, Japan, Pakistan, and the USA (n= 2) met the inclusion criteria. Data involving 1,589,207 primary hip and knee replacements, were included in the meta-analysis. There were 5985 superficial SSIs, out of total 420121 operations during the summer season, equating to a risk of 1.4%. During the other 3 seasons, there were 15364 Superficial SSIs out of 1169086 total operations, a risk of 1.3%. The pooled OR highlighted increased odds of developing superficial SSI for patients who underwent joint replacements during the summer months (OR 1.29, 95% confidence interval 1.05 – 1.60, P < 0.0001); with evidence of significant heterogeneity. Our preliminary meta-analysis suggests a 29% increased chance of having an SSI if the joint replacement was performed in the summer months. A high degree of heterogeneity was evident which warrants further exploration. Given the concerning consequences of developing wound infections after joint replacements, these findings may have important implications for informing individual patient-surgeon preoperative consent, surgical planning, and guiding future research

Malnutrition has been identified as an independent risk factor for surgical site infection (SSI). Guidelines advise that malnourished patients should be counselled and strategies implemented to improve nutritional intake prior to surgery. However, the current total hip replacement (THR) literature lacks of prospective clinical trials. The aim of this study was to investigate if the probability of acute SSI following THR is related to whether or not the patient had pre-operative low transferrin levels, low albumin levels and/or low total lymphocyte cell count (TLC). All patients receiving THR in a single Institution during a 2-year period were assessed prospectively for presence of malnutrition and SSI within 3 months after unilateral THR. Malnutrition was defined as albumin <35 g/L, transferrin <2g/L or TLC < 1.5 E. 9. /L. Patients with previous infection(s) were excluded. Multivariate analysis included gender, age, BMI, diabetes, and immunocompromised status. 478 patients with a complete dataset were included in the study; 137 (27.6%) had at least one low value of transferrin, TLC or albumin. SSI was recorded in 22 hips (4.6%) including 6 deep infections. Hypoalbuminaemia (RR, 1.28, p=0.5), low transferrin (RR, 1.39, p=0.4) or low TLC (RR, 1, p=0.1) were not associated with SSI. Multivariate analysis showed no association between abnormal blood tests suggesting malnutrition, BMI and SSI. Only BMI had a low p value for association with SSI (p=0.006). This study shows that abnormal blood tests associated with malnutrition are not an independent risk factor for SSI in THR

We aimed to use data from a randomized controlled trial (RCT) comparing the sliding hip screw vs. intramedullary nailing (IMN) for trochanteric fractures to examine complication rates between those managed with a short vs. long IMN. This is a secondary analysis using one arm of an RCT of patients ≥18 years with trochanteric fractures. We examined differences in fracture-related (femoral shaft fracture, implant failure, surgical site infection (SSI), nonunion, limb shortening, and pain) and medical (organ failure, respiratory distress, stroke, deep vein thrombosis [DVT] gastrointestinal upset, pneumonia, myocardial infarction, sepsis, or urinary tract infection) adverse events (AE), and readmission between short vs. long IMNs. We included 412 trochanteric fracture patients, 339 (82.2%) of whom received a short (170mm–200mm) nail, while 73 (17.7%) received a long (260mm–460 mm) nail. Patients in the long group were more likely to be admitted from home (vs. an institution), and have comorbidities, or more complex fracture types. Patients in the long group had higher rates of fracture-related AE (12.3%) vs. the short group (3.5%). Specifically, SSI (5.5% vs. 0.3%) and pain (2.7% vs. 0.0%) were significantly higher in the long group. Patients in the long group were also more likely to develop DVT (2.7% vs. 0.3%), and be readmitted to the hospital (28.8% vs. 20.7%). Following covariable adjustment, long nails remained associated with a higher odds of fracture-related AE (5.11, 1.96–13.33) compared to short nails. We found no association between the adjusted odds of readmission and nail length (1.00, 0.52–1.94). Our analyses revealed that trochanteric fracture patients managed with long IMN nails may have a higher odds of fracture-related AE compared to short nails. Future research is required to validate these findings with larger event rates, and further optimize IMN for trochanteric fracture patients

Introduction. Surgical site infection (SSI) remains a concern following total hip arthroplasty (THA). We aimed to identify risk factors for post-operative SSI in THA. Patients/Materials & Methods. All primary THAs performed in our institution during 2009–2010 were included, giving 1832 cases in 1716 patients. Cohort demographics were mean age 67.9 years (SD10.2), mean BMI 29.6 (SD5.3), 60% female and 90.2% primary indication of osteoarthritis. Post-operative SSI within one year was identified either through hospital infection control records or from Information Services Division (NHS Scotland). Demographic and peri-operative data for known or suspected risk factors for SSI were collected from clinical records. Groups were compared using independent t-tests and chi-squared tests as appropriate. Results. Within one year post-operatively, 27 patients (1.5%) developed SSI, with 23 (1.3%) being deep infections. The infected group had a higher mean BMI than the non-infected group (33.1 vs 30.0, p=0.001). 40.7% of the infected group had operative times ≥90 minutes compared to 22.7% in the non-infected group (p=0.026). Peri-operative blood transfusions were received by 25.9% of those developing infections but only 3.9% of those who did not (p<0.001). Discussion. The deep infection rate is similar to the national average and within the often quoted 2%. In keeping with other studies, these data have shown higher BMI, extended operative time and peri-operative blood transfusions to be risk factors for post-operative SSI. Obesity, along with other factors such as surgeon experience, may prolong surgical time and increase the risk of peri-operative blood transfusion, therefore leading to higher SSI rates. These results reinforce the importance of pre-operative weight loss for reducing SSIs. Conclusion. This study highlights that the rising incidence of obesity presents a serious ongoing challenge to surgeons performing THAs in terms of increasing risk of SSI. Reports of hospital infection rates should include the patient population BMI and be interpreted accordingly

After a hip fracture, infections are common, but signs of infection resemble those of systemic inflammatory response to trauma and surgery, and conventional infection markers lack specificity. Plasma-calprotectin, a novel marker of neutrophil activation, has shown potential as an infection marker in ER and ICU settings. To investigate if plasma-calprotectin is superior compared to conventional infection biomarkers after hip fracture. Prospective cohort study of hip fracture patients admitted to our department. Calprotectin, procalcitonin (PCT), C-reactive protein (CRP), and white blood cell (WBC) count were measured in blood plasma upon admission and on day 3 post-surgery. Patients with infection (pneumonia, UTI, sepsis, SSI, other soft tissue infections) pre- or post-surgery were compared to a control group without infection within 30 days. Statistics: Wilcoxon rank-sum test, medians with interquartile range, and area under the curve (AUC) with 95% confidence intervals. Pilot study comprises calprotectin obtained at least once for 60 patients at admission and 48 on day 3. Mean age 84 years (SD 8.4), 65% women. 9/60 patients (23%) were admitted with infections. They had higher levels of CRP (median 111 [73-149]) and PCT (0.35 [0.18–0.86]) compared to the control group (29 [16-64], p=0.037; 0.10 [0.07–0.17], p=0.007). Calprotectin (2.67 vs 2.51) and WBC (12.2 vs 9.3) did not differ significantly. AUC was highest for PCT (0.79 [CI 0.60–0.97]), followed by CRP (0.71 [0.46–0.96]), WBC (0.60 [0.35–0.84]), and calprotectin (0.58, [0.33–0.83]). Day 3, 6/48 (13%) had infections, without significant differences between groups in any marker. The median levels were: calprotectin 3.5 vs 3.1, CRP 172 vs 104, WBC 12 vs 9, PCT 0.16 vs 0.17. Calprotectin had highest AUC 0.68 (0.41–0.93, n.s.). AUC for WBC was 0.67 (0.31–1.00), CRP 0.66 (0.38–0.94), PCT 0.56 (0.29–0.82). Preliminary data show no significant associations with postoperative infection for any of the studied biomarkers. However, plasma-calprotectin might perform slightly better compared to conventional markers

Introduction. The prevalence of the various patterns of spinopelvic abnormalities that increase the risk for prosthetic impingement is unknown. While prior surgery or lumbar fusion are recognized as a risk factors for postoperative dislocation, many patients presenting for THA do not have obvious radiographic abnormalities. The purpose of this study is to determine the prevalence of large posterior pelvic tilt (PPT) when standing, stiff lumbar-spine (SLL) and spino-pelvic sagittal imbalance (SSI) in patients undergoing primary THA. Methods. A consecutive series of 1592 patients (56% female) over 2 years underwent functional analysis of spinopelvic mobility using CT, standing, and flexed seated lateral radiographs as part of pre-operative THA planning. The average age was 65 (20–93). We investigated the prevalence of these 3 validated spinopelvic parameters known to increase the risk for impingent and correlated them to the patient's age and gender using Chi squared analysis. Finally, the risk of flexion and extension impingement was modeled for each patient at a default supine cup orientation (DSCO) of 40°/20° (±5°). Results. Overall, 221 hips (14%) had at least 1 risk factor for impingement, while 64 (4%) had 2, and 18 (1 %) had all 3 risk factors. The most common risk factor was large PPT (10%) followed by SLL (4%) and SSI (4%). Female gender was not associated with increased spinopelvic abnormalities (p = 0.64), but age > 75 years increased the likelihood of at least having 1 risk factor (p<0.01) (Table-1). Placing the cup within the DSCO resulted in observed prosthetic impingement in 792 patients (50%) (Fig-1). 158 hips (20%) had at least 1 risk factor, while 56 (7%) had 2, and 16 (2 %) had all 3 risk factors for impingement. Posterior pelvic tilt was associated with extension impingement risk, while SLL and SSI increased flexion impingement risk. Conclusion. Spinopelvic risk factors that increase impingement risk are not infrequent in THA patients. We observed 50% prosthetic impingement when a single target for acetabular orientation target was applied. For any figures, tables, or references, please contact the authors directly

Introduction. Previous studies have indicated that prolonged surgical time may lead to higher rates of infection following total hip arthroplasty (THA). The purpose of this study was to evaluate the influence of surgical time on 30-day complications following THA and to determine if there was a time interval associated with worse outcomes. Methods. Patients ≥18 years who underwent THA between 2005 and 2016 were identified from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database using procedural codes. Patients with surgical durations >240 minutes were excluded. Patient demographics, operation length, and 30-day major and minor complications were ascertained. Multivariable regression was used to determine if the rate of complications differed depending on length of operation, while adjusting for relevant covariables, and to identify independent predictors of operation length. Covariables of interest included age, sex, American Society of Anaesthesiologists (ASA) class, smoking status, functional status, comorbidities, anesthesia type, and Body Mass Index (BMI). Results. A total of 132,043 THA patients (average age 65 ±12 years) were identified from the database. Of these, 2,177 (1.64%) experienced a major complication, and 3,504 (2.64%) experienced a minor complication within 30-days of the initial procedure. Average operation length was 92.0 minutes (range 20 – 240 minutes). Independent predictors of prolonged operation length included overweight/obese BMI, male sex, cancer, dependent functional status, epidural anaesthetic, and ASA class II, III or IV vs. I Alternatively, older age, current smoking, and spinal anaesthetic were associated with shorter surgical durations. Unadjusted rates of both major and minor complications were significantly higher for patients whose operation lengths were ≥ 120 minutes (P>0.001). Specifically, patients whose operations lasted ≥ 120 minutes had higher rates of septic shock, sepsis, pulmonary embolism (PE), deep vein thrombosis (DVT), urinary tract infection (UTI), renal insufficiency, surgical site infection(SSI) and wound disruption. After covariable adjustment, surgical durations of 90–119 minutes increased the risk of minor complications by 1.2 (95%Confidence interval [95%CI] 1.1–1.3), while surgical durations of 120–180 minutes increased the risk of major complications by 1.4 (95%CI 1.3 – 1.6), and minor complications by 1.4 (95%CI 1.2 – 1.5), and surgical durations ≥180 minutes increased the risk of major complications by 2.1 (95%CI 1.8 – 2.6), and minor complications by 1.9 (95%CI 1.6 – 2.3). There was no difference in the overall risk of complications for operation times lasting 20 – 39, 40 – 59, or 60 – 89 minutes (P>0.05). In terms of specific complications, operation length ≥90 minutes was determined to be an independent risk factor for deep and superficial incisional SSI, as well as wound disruption, while operation length ≥ 120 minutes was an independent risk factor for sepsis, UTI, and deep, non-incisional SSI and operation length ≥ 180 minutes was an independent risk factor for PE, DVT, and cardiac arrest (p<0.05). Conclusion. These data indicate that prolonged surgical durations may be an independent predictor of major and minor complications following THA. This suggests that quality improvements could be made to improve operating room efficiency and surgical times and therefore postoperative outcomes

Aims. Intravenous dexamethasone has been shown to reduce immediate postoperative pain after total hip arthroplasty (THA), though the effects are short-lived. We aimed to assess whether two equivalent perioperative split doses were more effective than a single preoperative dose. Methods. A total of 165 patients were randomly assigned into three groups: two perioperative saline injections (Group A, placebo), a single preoperative dose of 20 mg dexamethasone and a postoperative saline injection (Group B), and two perioperative doses of 10 mg dexamethasone (Group C). Patients, surgeons, and staff collecting outcome data were blinded to allocation. The primary outcome was postoperative pain level reported on a ten-point Numerical Rating Scale (NRS) at rest and during activity. The use of analgesic and antiemetic rescue, incidence of postoperative nausea and vomiting (PONV), CRP and interleukin-6 (IL-6) levels, range of motion (ROM), length of stay (LOS), patient satisfaction, and the incidence of surgical site infection (SSI) and gastrointestinal bleeding (GIB) in the three months postoperatively, were also compared. Results. The pain scores at rest were significantly lower in Groups B and C than in Group A on postoperative days 1 and 2. The dynamic pain scores and CRP and IL-6 levels were significantly lower for Groups B and C compared to Group A on postoperative days 1, 2, and 3. Patients in Groups B and C had a lower incidence of PONV, reduced use of analgesic and antiemetic rescue, improved ROM, shorter LOS, and reported higher satisfaction than in Group A. Patients in Group C had significantly lower dynamic pain scores and IL-6 and CRP levels on postoperative days 2 and 3, and higher ROM and satisfaction on postoperative day 3 than in Group B. No SSI or GIB occurred in any group. Conclusion. Perioperative dexamethasone provides short-term advantages in reducing pain, PONV, and inflammation, and increasing range of motion in the early postoperative period after THA. A split-dose regimen was superior to a single high dose in reducing pain and inflammation, and increasing ROM, with better patient satisfaction. Level of evidence: I. Cite this article: Bone Joint J 2020;102-B(11):1497–1504

Introduction. Wound complications following revision total hip arthroplasty (THA) are associated with an increased risk of superficial and deep infections. Closed incision negative-pressure therapy (ciNPT) has been reported to decrease this risk. This study's purpose was to assess if ciNPT decreases the rate of wound complications following revision THA versus a conventional, silver-impregnated dressing. Methods. This was a single center, randomized controlled trial of patients undergoing both septic and aseptic revision THA. Patients received either ciNPT or a silver-impregnated dressing (control) for 7 days. Wound complications within 90 days of the procedure were recorded, including: surgical site infection (SSI), periprosthetic joint infection (PJI), prolonged drainage greater than 5 days, erythema requiring antibiotics, and hematoma formation. An a priori power analysis determined 201 patients per cohort were necessary to demonstrate a 10% decrease in wound complication rate. Results. Between 2017 and 2020, 113 patients have been enrolled: 57 (50.4%) to ciNPT and 56 (49.6%) to the control dressing. Two revisions (1.8%) were performed via a direct lateral approach; all others via a posterior approach. There were no differences in age, BMI, ASA score, revision performed, wound closure method (staples, superficial nylons, subcuticular), or postoperative anti-coagulation (p=0.2–0.8). Seven (12.3%) patients in the ciNPT cohort sustained a wound complication versus 4 (7.1%) in the control cohort (p=0.2). There was no difference in type of wound complication sustained (p=0.4). Four (7.0%) patients in the ciNPT cohort underwent re-operation for wound-related complications (2 PJI, 1 SSI, 1 prolonged drainage) versus zero in the control cohort (p=0.04). Conclusion. Prior studies have shown ciNPT to be effective in decreasing the rate of wound complications in total joint arthroplasty. Preliminary results of this randomized trial of revision THA patients do not corroborate these prior reports. Continued enrollment is required to confirm these initial findings

We have analysed the management and clinical outcome of a series of consecutive patients who had a total hip replacement and developed post-operative surgical site infection (SSI) with methicillin-resistant Staphylococcus aureus. The incidence of this infection was 1% over a period of five years. We studied SSI in 15 patients (16 infections) with a mean age of 72.7 years (53 to 81). In all, 12 of the infections occurred early and half of the infections involved the prosthesis, resulting in an increase of 11-fold in the cumulative hospital stay. Methicillin-resistant Staph. aureus was successfully eradicated in all the patients after a mean follow-up of 53.6 months (25 to 88). Superficial incisional infections resolved after antibiotic therapy alone while deep infections required multiple operative debridements. Attempted retention of the implant in early organ space infections was successful in only one of five patients. Only three patients with implant-level infections obtained a pain-free, functional prosthesis while a further three required excision arthroplasty. We have formulated a protocol of treatment which may serve as a guide in the management of these infections

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.

Introduction. The obesity epidemic is a growing problem and must be considered with the projected increased demand for total hip arthroplasty (THA). Previous studies have reported increased complication rates after THA in the obese population, which has led to hesitation in offering surgery to this population. Moreover, some insurers are denying coverage for morbidly obese patients. While many consider obesity a “modifiable” risk factor, very few patients with advanced osteoarthritis have successfully lost substantial weight. The experience of centers that utilize systematic preoperative risk stratification tools and standardized postoperative total joint pathways may be underrepresented in prior studies. The aim of this study is to describe one surgeon's experience performing THA in morbidly and super-obese patient populations using an institutional preoperative Risk Stratification Tool (RST) and total joints pathway. Methods. We conducted a retrospective review of patients undergoing primary THA between May 2014 and December 2017 performed by a single surgeon at a tertiary care referral center. All patients were assessed preoperatively using an institutional RST and had a minimum of 90-day postoperative follow up. Patients were stratified by body mass index (BMI, kg/m. 2. ): non-obese (BMI < 30), obese (30–34), severely obese (35–39), morbidly obese (40–44), and super-obese (≥ 45). Primary outcomes were inpatient and 90-day complications. Continuous and binary parameters were analyzed by Kruskal-Wallis and Fisher exact tests. Logistic regression was additionally utilized to evaluate outcomes by BMI cohort. Results. A consecutive series of 368 patients met inclusion criteria across all BMI cohorts. There was significant variation with respect to age (P=0.001), BMI (P<0.001), diabetes (P=0.008), ASA class (P<0.001), and anesthesia type (P=0.003) (Table 1). Variation among BMI cohorts was also identified for several operative and postoperative parameters, including longer operative and in-room time and greater length of stay (P<0.001) (Table 2). Compared to non-obese patients, super-obese patients had 20.1 greater odds of return to OR within 90 days for superficial surgical site infection (SSI) or prolonged round drainage (P=0.008) (Table 3). Notably, morbidly and super-obese patients were not at significantly increased risk for inpatient intensive care unit (ICU) transfer, blood transfusion, 90-day emergency room visit, or 90-day readmission compared to their non-obese counterparts. For patients in whom 1-year follow-up was available, these differences between BMI cohorts remained insignificant. Conclusions. Patients with BMI>40 are more likely than non-obese patients to have increased postoperative rehabilitation needs but are not at increased risk for in-hospital complications. Super-obese patients have greater risk of superficial SSI or prolonged wound drainage than non-obese patients but are not at increased risk for revision or deep infection in any cohort. Use of a preoperative RST may help to mitigate postoperative complications and readmissions previously associated with morbid and super-obesity. We conclude that THA can be safely performed in super-obese patients and therefore care should not be denied to this population. Summary sentence. Total hip arthroplasty (THA) can be safely performed in morbidly and super-obese patients with the use of a preoperative risk stratification tool (RST) and total joints pathway. For any tables or figures, please contact the authors directly

Aims

The aim of this study was to explore the functional results in a fitter subgroup of participants in the Hip Fracture Evaluation with Alternatives of Total Hip Arthroplasty versus Hemiarthroplasty (HEALTH) trial to determine whether there was an advantage of total hip arthroplasty (THA) versus hemiarthroplasty (HA) in this population.

Aims

The aim of this study was to evaluate the suitability of the tapered cone stem in total hip arthroplasty (THA) in patients with excessive femoral anteversion and after femoral osteotomy.

Aims

Total hip arthroplasty (THA) using the direct anterior approach (DAA) is undertaken with the patient in the supine position, creating an opportunity to replace both hips under one anaesthetic. Few studies have reported simultaneous bilateral DAA-THA. The aim of this study was to characterize a cohort of patients selected for this technique by a single, high-volume arthroplasty surgeon and to investigate their early postoperative clinical outcomes.

Aims

The aim of this study was to assess the influence of operating time on 30-day complications following total hip arthroplasty (THA).

Aims

We studied the impact of direct anterior (DA) versus non-anterior (NA) surgical approaches on prosthetic joint infection (PJI), and examined the impact of new perioperative protocols on PJI rates following all surgical approaches at a single institution.

The World Health Organization (WHO) and the Centre for Disease Control and Prevention (CDC) recently published guidelines for the prevention of surgical site infection. The WHO guidelines, if implemented worldwide, could have an immense impact on our practices and those of the CDC have implications for healthcare policy in the United States.

Our aim was to review the strategies for prevention of periprosthetic joint infection in light of these and other recent guidelines.

Cite this article: Bone Joint J 2017;99-B(4 Supple B):3–10.