Introduction. Smoking, a modifiable factor, may adversely affect post-operative outcomes. Healthcare providers are increasingly denying smokers access to total hip arthroplasty (THA) until they stop smoking. Evidence supporting this is unclear. We assessed the effect of smoking on outcomes following THA. Patients and Methods. We performed a retrospective observational study involving 60,812 THAs (12.4%=smokers, 31.2%=ex-smokers, 56.4%=non-smokers) from the Clinical Practice Research Datalink. Data were linked with Hospital Episode Statistics and the Office for National Statistics to identify outcomes. The effect of smoking on post-operative outcomes (complications, medications, revision, mortality, PROMs) was assessed using adjusted regression. Results. Following THA, smokers had a significantly increased risk of lower
Aims. Thromboprophylaxis following Total Hip Replacement (THR) surgery remains controversial, balancing VTE prevention against wound leakage and subsequent deep infection. We analysed the 90 day cause of death post THR in our institution after the implementation of new thromboprophylactic policy of low dose aspirin for low risk patients, as part of a multimodal regime. Those at high risk were anticoagulated. Patients and methods. The PAS database was used to identify patients undergoing primary THR between January 2012 and June 2017 at The Royal Derby Hospital, and all deaths within 90 days. Trauma cases were excluded. Case note review and Coroner's verdict were utilised to ascertain cause of death. Results were compared to a previous study at the same institution prior to the introduction of the new policy, where thromboprophylaxis was decided upon by surgeon preference for either LMWH, aspirin or warfarin. Results. During this period 4021 THRs were performed. The rate of mortality was 0.22% at 90 days. This compares to 0.58% in the previous study with the only other factor changing being the rapidity of post op mobilization. Of the 9 deaths, only one was due to fatal pulmonary embolism. None of the deaths were at high risk of VTE. This compared to 5 fatal pulmonary embolism deaths in1838 patients in the previous study in the LMWH group. The leading causes of death were heart failure and lower
The number of revision arthroplasties being performed in the elderly is expected to rise, including revision for infection. The primary aim of this study was to measure the treatment success rate for octogenarians undergoing revision total hip arthroplasty (THA) for periprosthetic joint infection (PJI) compared to a younger cohort. Secondary outcomes were complications and mortality. Patients undergoing one- or two-stage revision of a primary THA for PJI between January 2008 and January 2021 were identified. Age, sex, BMI, American Society of Anesthesiologists grade, Charlson Comorbidity Index (CCI), McPherson systemic host grade, and causative organism were collated for all patients. PJI was classified as ‘confirmed’, ‘likely’, or ‘unlikely’ according to the 2021 European Bone and Joint Infection Society criteria. Primary outcomes were complications, reoperation, re-revision, and successful treatment of PJI. A total of 37 patients aged 80 years or older and 120 patients aged under 80 years were identified. The octogenarian group had a significantly lower BMI and significantly higher CCI and McPherson systemic host grades compared to the younger cohort.Aims
Methods
A typical pattern of blood loss associated with total hip arthroplasty (THA) is 200 ml intraoperatively and 1.3 l in the first 48 postoperative hours. Tranexamic acid (TXA) is most commonly given as a single preoperative dose only and is often withheld from patients with a history of thromboembolic disease as they are perceived to be “high-risk” with respect to postoperative venous thromboembolism (VTE). The TRanexamic ACid for 24 hours trial (TRAC-24) aimed to identify if an additional 24-hour postoperative TXA regime could further reduce blood loss beyond a once-only dose at the time of surgery, without excluding these high-risk patients. TRAC-24 was a prospective, phase IV, single centre, open label, parallel group, randomized controlled trial (RCT) involving patients undergoing primary unilateral elective THA. The primary outcome measure was the indirect calculated blood loss (IBL) at 48 hours. The patients were randomized into three groups. Group 1 received 1 g intravenous (IV) TXA at the time of surgery and an additional oral regime for 24 hours postoperatively, group 2 only received the intraoperative dose, and group 3 did not receive any TXA.Aims
Methods
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. 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.Aims
Methods
The place of thromboprophylaxis in arthroplasty surgery remains
controversial, with a challenging requirement to balance prevention
of potentially fatal venous thrombo-embolism with minimising wound-related
complications leading to deep infection. We compared the incidence
of fatal pulmonary embolism in patients undergoing elective primary
total hip arthroplasty (THA) between those receiving aspirin, warfarin
and low molecular weight heparin (LMWH) for the chemical component
of a multi-modal thromboprophylaxis regime. A prospective audit database was used to identify patients who
had died within 42 and 90 days of surgery respectively between April
2000 and December 2012. A case note review was performed to ascertain
the causes of death.Aims
Patients and Methods
Total hip replacement (THR) has been shown to
be a cost-effective procedure. However, it is not risk-free. Certain conditions,
such as diabetes mellitus, are thought to increase the risk of complications.
In this study we have evaluated the prevalence of diabetes mellitus
in patients undergoing THR and the associated risk of adverse operative
outcomes. A meta-analysis and systematic review were conducted according
to the guidelines of the meta-analysis of observational studies
in epidemiology. Inclusion criteria were observational studies reporting
the prevalence of diabetes in the study population, accompanied
by reports of at least one of the following outcomes: venous thromboembolic
events; acute coronary events; infections of the urinary tract,
lower respiratory tract or surgical site; or requirement for revision
arthroplasty. Altman and Bland’s methods were used to calculate differences
in relative risks. The prevalence of diabetes mellitus was found
to be 5.0% among patients undergoing THR, and was associated with
an increased risk of established surgical site infection (odds ratio
(OR) 2.04 (95% confidence interval (CI) 1.52 to 2.76)), urinary
infection (OR 1.43 (95% CI 1.33 to 1.55)) and lower respiratory
tract infections (OR 1.95 (95% CI 1.61 to 2.26)). Diabetes mellitus
is a relatively common comorbidity encountered in THR. Diabetic
patients have a higher rate of developing both surgical site and
non-surgical site infections following THR. Cite this article:
