Mortality After Revision Total Hip Arthroplasty

Laughlin, Mitzi S.; Vidal, Emily A.; Drtil, Arin A.; Goytia, Robin N.; Mathews, Vasilios; Patel, Anay

doi:10.1016/j.arth.2021.01.022

Cited by 16 publications

(15 citation statements)

References 24 publications

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“…15,17,19,23,24 This result was higher than that of 2 recently published articles reporting 30-day mortality rates after revision THA, 9,13 but less than that reported in 2009. 15 Laughlin et al 9 reported an overall 0.337% 30-day mortality rate after revision THA in a cohort of 596 patients who had their first revision THA from January 2012 to December 2018 at a tertiary care centre. Interestingly, in their subgroup analysis, no mortalities occurred due to PJI in their 2-year follow-up.…”

Section: Discussioncontrasting

confidence: 54%

“…Interestingly, in their subgroup analysis, no mortalities occurred due to PJI in their 2-year follow-up. 9 Likewise, Jones et al 13 in a case-control study reported a 0.357% 30-day mortality rate following revision THA. Separately, in a retrospective analysis of an institutional database with 1206 patients who underwent revision THA, Aynardi et al 15 reported a perioperative mortality rate of 0.83% (10/1206).…”

Section: Discussionmentioning

confidence: 98%

“…3 An increasing demand and utilisation of primary THA in younger patients, 4 –6 whom are cited to have decreased survivorship, 1,7 and an ageing general population with increased life expectancy are significant factors that will continue to contribute to the growing revision burden in the coming years. 8,9…”

Section: Introductionmentioning

confidence: 99%

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Understanding the 30-day mortality burden after revision total hip arthroplasty

et al. 2022

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Background: Revision total hip arthroplasty (THA) is a challenging procedure that burdens the healthcare system. Despite being associated with worse outcomes relative to its primary counterpart, postoperative mortality after revision THA remains ill-defined. The present study aimed to (1) establish the overall 30-day mortality rate after revision THA and (2) explore the mortality rate stratified by age, comorbidity burden, and aseptic versus septic failure. Methods: The American College of Surgeons – National Surgical Quality Improvement Program (ACS-NSQIP) database was retrospectively reviewed for all patients who underwent revision THA from 2011 to 2019. A total of 23,501 patients were identified and grouped into mortality ( n = 161) and mortality-free ( n = 23,340) cohorts. Patient demographics, comorbidities, and aseptic/septic failure were evaluated. Results: The overall 30-day mortality was 0.69%. The mortality rate by age group (normalised per 1000 patients) was 0 (18–39 years [Y]), 0.67 (40–49 Y), 1.10 (50–59 Y), 2.58 (60–69 Y), 6.15 (70–79 Y) 19.32 (80–89 Y), and 58.22 (90+Y) ( p < 0.001). The mortality rate by ASA classification (normalised per 1000 patients) was 0 (ASA I), 1.47 (ASA II), 6.94 (ASA III), 45.42 (ASA IV), and 200 (ASA V) ( p < 0.001). The 30-day mortality rate for the septic and aseptic cohorts was 1.03% and 0.65%, respectively ( p = 0.038). CCI scores ( p < 0.001), diabetes ( p < 0.001), systematic sepsis ( p < 0.001), poor functional status ( p < 0.001), BMI < 24.9 kg/m2 ( p < 0.001), and dirty/infected wounds ( p < 0.001) were all associated with increased mortality risk. Conclusions: 1 in 145 patients will suffer mortality during the 30 days after revision THA. PJI-related revision THA was associated with 1.5-fold increase in 30-day mortality rate compared to its aseptic counterpart. Certain patient determinants and baseline comorbidities, as measured by ASA and CCI scores, were associated with higher 30-day mortality rates. Therefore, it is imperative to identify such risk factors and implement perioperative patient optimisation pathways to mitigate the risk among vulnerable patients.

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Section: Discussioncontrasting

confidence: 54%

Section: Discussionmentioning

confidence: 98%

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Understanding the 30-day mortality burden after revision total hip arthroplasty

et al. 2022

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“…Due to their high persistency (low solubility), the interaction of wear debris with cells and tissues induce a complex immune response that can lead to periprosthetic osteolysis (degeneration of bone causing aseptic loosening) and implant failure with a consequent need of a revision surgery [3][4][5][7][8][9][10]. Besides the severe consequences for the patients' health conditions (e.g., higher rates of mortality, hospital readmission, dislocation, and infection), revision surgeries pose a high nancial burden on healthcare systems (longer surgery time, expensive prostheses, longer hospitalization periods, and higher rates of health complications) [10][11].…”

Section: Discussionmentioning

confidence: 99%

Osteoblasts-derived Exosomes as Novel Communicators in Particle Induced Periprosthetic Osteolysis

Souza

Gemini-Piperni

Ruivo

et al. 2021

Preprint

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BackgroundThe inflammatory response to titanium implant-derived wear particles is considered as the hallmark of periprosthetic osteolysis, an event that cause pain, reduce patient motility, ultimately leading to the need of a revision surgery. Although macrophages are major cell players, other cell types such as bone cells can indirectly contribute to periprosthetic osteolysis, however the mechanisms are not fully understood. Exosomes (Exos) has been related with several bone pathologies, with growing body of literature recognizing them as actively shuttle molecules through the body, with their cargo being completely dependent of external stimuli (e.g. chemicals and metals ions and particles). Till the moment, the role of wear debris on osteoblasts exosomes biogenesis is absent and the possible contribution of Exos to osteoimmune communication and periprosthetic osteolysis is still in its infancy. Taking that in consideration, in this work we investigate the effect of wear debris on Exo biogenesis, where two bone cell models were exposed to titanium dioxide nanoparticles (TiO2 NPs) similar in size and composition to wear debris associated with prosthetic implants. The contribution of Exos to periprosthetic osteolysis was evaluated performing functional tests stimulating primary human macrophages with bone-derived Exos.ResultsFor the first time, we report that TiO2 NPs enter in multivesicular bodies, the nascent of Exos and altered osteoblasts derived exosomes secretion and cargo. No significant differences were observed in Exos morphology and size, however mass spectrometry analysis identified urokinase-type plasminogen activator (uPA), specifically enriched in Exos derived from bone cells pre-incubated with TiO2 NPs. Functional tests confirmed the activation of human macrophages towards a mixed phenotype with consequent secretion of pro and anti-inflammatory cytokines. ConclusionsThe external stimuli of osteoblasts to TiO2 NPs induced a dose dependent secretion of Exos, suggesting alterations in their biogenesis as well as in their cargo. Functional tests reveal that enriched uPA exosomal cargo is stimulating macrophages towards a mixed M1 and M2 phenotype inducing the release of pro-and anti-inflammatory signals that are characteristic of periprosthetic osteolysis. Interestingly, uPA may be proposed, in the future, as a possible candidate biomarker to early diagnose particle induced periprosthetic osteolysis, since uPA was also detected in the pseudocapsular interface around implants of patients with loosening of total hip prosthesis and joint replacement surgery, suggesting their active role in disease progression.

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“…After undergoing rTHA, patients are up to 5 times more likely to require subsequent re-revision compared to patients undergoing primary THA [3]. All-cause perioperative mortality after rTHA is another important consideration and has been reported to be as high as 7 deaths per 1000 at 90 days, which is almost double that of comparable cohorts undergoing primary THA [4]. Finally, rTHA procedures are associated with increased operative time, increased blood loss, increased length of stay, and cost compared to primary THA.…”

mentioning

confidence: 99%