Predictive value of lateral soft tissue thickness for complications after total hip arthroplasty with a lateral incision

Markman

Geriatr Orthop Surg Rehabil

et al. 2022

Introduction Surgical site infection (SSI) following fragility hip fracture (FHF) surgery is associated with increased morbidity and mortality. Significance Prediction of patients at risk for SSI is fundamental. We aimed to determine whether subcutaneous radiographic fat measurement (SRM) is associated with increased SSI risk. Methods A retrospective case-control comparison of SRMs at 3 locations around the hip. Patients diagnosed with SSI in the first post-operative year were matched with age, gender, surgical year, Charlsons’ co-morbidity index score, and surgical type controls, not diagnosed with SSI, at a 1:2 ratio. Measurements included the distance between (1) the sourcil to skin surface (SS), (2) the tip of the greater trochanter to skin surface (TGTS), and (3) the most prominent lateral aspect of the greater trochanter to skin surface. Results 1430 patients were operated during the study period, of whom 45 patients presented with a diagnosis of SSI and compared to 90 controls. Infections occurred 27.4 ( ± 24.8) days following surgery. SRM significantly differed between groups, and all were higher in the study group; SS, 86.8 ± 25.5 cm vs 74.2 ± 15.3 cm; TGTS, 59.8 ± 26.3 cm vs 47.0 ± 15.8 cm; and LGTS, 45.4 ± 25.1 cm vs 33.2 ± 15.1 cm ( P = .003, .004, and .004, respectively). Intraclass correlation coefficients (intra-rater) were high for all measurements (.999 for all). Intraclass correlation coefficients (inter-rater) for SS, TGTS and LGTS were high, .749 (.663.815), .792 (.719.847) and .817 (.751.866), respectively. Conclusions SRMs were found to be a valid and reproducible tool for predicting high risk of SSI in geriatric patients sustaining FHFs. Level of Evidence III.

Section: Discussionmentioning

confidence: 91%

Section: Introductionmentioning

confidence: 99%

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Thickness of the Subcutaneous Fat as a Risk Factor for Surgical Site Infection Following Fragility Hip Fracture Surgery

Markman

Geriatr Orthop Surg Rehabil

et al. 2022

“…The results of our study suggest an association between the SRM at the hip and the risk of APJI in patients after total hip replacement surgery. Sprowls et al (2020a) retrospectively reviewed 1110 patients, identifying increased lateral soft-tissue thickness and body mass index as factors associated with surgical site infection and deep infection and lateral soft-tissue thickness with revision surgery as well. A value > 5 cm was predictive of surgical site infection, deep infection, and revision surgery.…”

Section: Discussionmentioning

confidence: 99%

Soft-tissue thickness radiographic measurement: a marker to evaluate acute periprosthetic joint infection risk in total hip replacement

Fernández

Crespo

Álvarez

et al. 2021

J. Bone Joint Infect.

Abstract. The objective of our study was to evaluate the association between acute periprosthetic joint infection (APJI) and radiographic measurement of soft-tissue thickness in elective total hip replacement surgery. A case-control study was conducted to compare the soft-tissue thickness radiographic measurement (SRM) at the hip in patients diagnosed with APJI based on Tsukayama et al. (2003) criteria after total hip replacement with patients that were not infected, at a single institution from 2013 to 2019. To minimize selection bias, each case was matched with two controls using the following methodology: patients of the same sex, with an age variation of ± 5 years, and nearest in surgery date to the cases were selected. All postoperative radiographs were performed in the first 24 h after total hip arthroplasty (THA) surgery as it is protocolized in our institution. Soft-tissue thickness radiographic measurement was defined as the distance from the tip of the greater trochanter to the skin following a perpendicular line to the femoral diaphysis in postoperative anteroposterior hip radiographs. In total, 78 patients were included (26 cases and 52 controls). The SRM median of the cases was 76.19 mm (SD: 26.518) and 53.5 mm (SD: 20.47) in controls. A multivariate logistic regression model showed an independent association between APJI and SRM (odds ratio (OR) = 1.033, 95 % confidence interval (CI) 1.007–1.059, p=0.012). Patients with an SRM greater than 60 mm had a 7-fold increase in the odds of APJI (OR = 7.295, 95 % CI = 2.364–22.511, p<0.001). The results of our study suggest an association between large SRM at the hip and the risk of APJI in patients with primary total hip arthroplasty. SRM may be a helpful and easy tool for evaluating the risk of APJI before elective primary total hip replacement surgery.

“…It does not take into consideration fat distribution or muscle composition 14,15 . Other specific quantification methods, such as percent body fat, have been shown to correlate more closely with perioperative risks after TJA but requires specialized testing that may not be readily available 16,17 .…”

mentioning

confidence: 99%

Local Soft-Tissue Thickness vs. Body Mass Index as Predictors of Complications After Total Knee or Hip Arthroplasty

Parikh,

Pannu,

Davis

et al. 2023

JBJS Reviews

» Body mass index (BMI) is a nonspecific measure of general fat composition that demonstrates little conclusive or definitive association with surgical site complications after total knee and total hip arthroplasty.» Quantifying soft-tissue thickness (STT) around the joint of interest has shown positive correlations with complications and is arguably a better predictor than BMI.» In this literature review, 14 articles (7 discussing hips and 7 discussing knees) discussing the association of STT, BMI, and surgical site complications after total hip and knee arthroplasty were scrutinized and summarized to present relevant information necessary to compare STT with BMI.» Five of the 7 studies involving hips and 4 of the 7 studies involving knees show a positive relationship between STT and outcomes including complications and infection, with some claiming STT as a stronger predictor of surgery site problems than BMI.» Since many variables, such as STT measurement technique, surgical outcomes, sample sizes, and surgical approach, varied between the studies, definitive inferences are difficult to make and future studies of bigger sample size and higher power should focus on the described measurement techniques.