Monitoring the one year postoperative infection rate after primary total hip replacement

Biau, David; Leclerc, Philippe; Marmor, Simon; Zeller, Valérie; Graff, Wilfrid; Lhotellier, Luc; Léonard, Philippe; Mamoudy, P.

doi:10.1007/s00264-011-1444-y

Cited by 13 publications

(8 citation statements)

References 30 publications

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“…Despite these limitations, our study reports on the largest, prospectively followed, homogenous cohort of HIV+ patients undergoing elective primary THA with detailed immunologic data. Our data suggest that even in well-managed, well-resourced, medically optimized patients living with HIV, we may anticipate a higher rate of risk for SSI than that reported in the general THA population (2% or less) [ 28 , 55 ]. Based on these results, it does not appear that the risk of SSI in these patients is associated with any particular immunologic laboratory value or associated medical comorbidity but may be explained by subtler and more complex metabolic and inflammatory changes that occur with a long-term history of HIV infection and its associated treatment.…”

Section: Discussionmentioning

confidence: 81%

Metabolic factors and post-traumatic arthritis may influence the increased rate of surgical site infection in patients with human immunodeficiency virus following total hip arthroplasty

et al. 2020

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Background The impact of CD4+ T-cell count and highly active antiretroviral therapy (HAART) on the rate of surgical site infection (SSI) in patients with human immunodeficiency virus (HIV) undergoing total hip arthroplasty is still unclear. The goals of this study were to assess the rate of perioperative infection at a large tertiary care referral center and to identify risk factors in HIV+ patients undergoing total hip arthroplasty (THA). Methods This study was a prospective, observational study at a single medical center from 2000–2017. Patients who were HIV+ and underwent THA were followed from the preoperative assessment period, through surgery and for a 2-year follow-up period. Results Sixteen of 144 HIV+ patients (11%) undergoing THA developed perioperative surgical site infections. Fourteen patients (10%) required revision THA within a range of 12 to 97 days after the initial surgery. The patients’ mean age was 49.6 ± 4.5 years, and the most common diagnosis prompting THA was osteonecrosis (96%). Patients who developed SSI had a lower waist-hip ratio (0.86 vs. 0.93, p = 0.047), lower high density lipoprotein cholesterol (45.8 vs. 52.5, p = 0.015) and were more likely to have post-traumatic arthritis (12.5% vs. 0%, p = 0.008). Logistic regression analysis demonstrated that current alcohol use and higher waist-hip ratio were significant protectors against infection ( p < 0.05). No other demographic, medical, immunologic parameters, or specific HAART regimens were associated with perioperative infection. Conclusions Immunologic status as measured by CD4+ cell count, HIV viral load, and medical therapy do not appear to influence the development of SSI in HIV+ patients undergoing THA. Metabolic factors and post-traumatic arthritis may influence the increased rate of infection in HIV+ patients following THA.

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Section: Discussionmentioning

confidence: 81%

Metabolic factors and post-traumatic arthritis may influence the increased rate of surgical site infection in patients with human immunodeficiency virus following total hip arthroplasty

et al. 2020

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“…This finding may be useful when considering the redesign of arthroplasty review services. Other tools may also be useful in the early detection of a unit's change complication rate [17]. A main strength of this study is its prospective data collection as part of a regional arthroplasty audit project.…”

Section: Discussionmentioning

confidence: 99%

The natural history of unexplained early poor function following total hip replacement

Watson

Jenkins

Ballantyne

2013

International Orthopaedics (SICOT)

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Purpose The majority of patients experience a significant improvement in quality of life and function after total hip replacement (THR). It has recently been shown that age and good pre-operative function are the best predictors of postoperative function. When patients fail to achieve a satisfactory outcome, a cause is often identified. Where there is no identifiable cause, advice, follow-up and management is not clear. The aim of this study was to determine the long-term outcome of patients who had early poor function, but no identifiable cause. Methods From a regional database, we identified 1,564 patients who underwent unilateral THR between 1998 and 2004 and who were without complication or subsequent bilateral procedure at six months. These patients were divided into two groups according to their Harris hip score (HHS) at this stage: group A consisted of 270 patients with a 'poor' result (HHS less than 70). Group B consisted of 1,294 patients with a 'good' or 'excellent' result (HHS 70 or above). The patients were reviewed at five years. One hundred and ten patients from group A and 980 from group B completed five-year followup without further identifiable complication. Results Those with poor or fair function at six months were at an increased risk of developing an identified complication by five years including dislocation (OR 5.7, 95 % CI 1.8-18.2), deep infection (OR 9.8, 95%CI 2.9-37.7) and death (OR 1.6, 95 % CI 1.1-2.3). There was a greater rate of revision in group A versus group B (OR 5.7, 95 % CI 2.9-11). The overall function measured by the Harris hip score significantly improved in group A, but never reached that of those with good or excellent function at six months (HHS 76.2 versus 90.3, P <0.001).Conclusions Patients with poor function at six months, but no obvious cause, are at higher risk of developing complications by five years. This group may benefit from more regular arthroplasty review and intervention.

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“…Infection is one of the most commonly described complications of THR in dogs The reported incidence of infection after primary total hip replacement is under one percent in most large human orthopaedic centres (20). Reports of infected total hip replacements in dogs are uncommon.…”

Section: A B Cmentioning

confidence: 99%

One-stage revision of an infected cementless total hip replacement

Ficklin¹,

Kowaleski²,

Kunkel³

et al. 2016

Vet Comp Orthop Traumatol

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A two-year-old, 44 kg dog with a right Helica cementless total hip replacement (THR) was radiographically diagnosed with implant loosening eight months after the index total hip replacement procedure. Subsequent synoviocentesis and synovial fluid culture revealed a methicillin-resistant coagulase-negative Staphylococcus spp infection of the right THR. A one-stage revision using a hybrid BFX cementless acetabular cup and CFX cemented femoral stem was performed. Vancomycin and micro-silver antimicrobial powder impregnated cement were used in the revision. At re-evaluation 27 months following the revision procedure, the patient did not exhibit any signs of lameness. Radiographic images confirmed stable implants, with bone ingrowth into the cup and no signs of implant loosening. Our report demonstrates the success of a one-stage THR revision when faced with a multi-drug resistant periprosthetic infection, when combined with the use of micro-silver antimicrobial powder and culture-based antibiotic impregnated cement therapy.

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Monitoring the one year postoperative infection rate after primary total hip replacement

Cited by 13 publications

References 30 publications

Metabolic factors and post-traumatic arthritis may influence the increased rate of surgical site infection in patients with human immunodeficiency virus following total hip arthroplasty

Metabolic factors and post-traumatic arthritis may influence the increased rate of surgical site infection in patients with human immunodeficiency virus following total hip arthroplasty

The natural history of unexplained early poor function following total hip replacement

One-stage revision of an infected cementless total hip replacement

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