Severely Obese Patients Have a Higher Risk of Infection After Direct Anterior Approach Total Hip Arthroplasty

Purcell, Richard L.; Parks, Nancy L.; Gargiulo, Jeanine M.; Hamilton, William G.

doi:10.1016/j.arth.2016.03.037

Cited by 57 publications

(30 citation statements)

References 17 publications

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“…While the cause is unclear, during this period the hospital had an increase in infection rates and a thorough evaluation by infectious disease experts was performed with no clear cause identified. One consideration is that 6 of the 7 patients with PJI had a BMI greater than 30 kg/m 2 which has been shown to be a risk factor for PJI in patients having THA through an anterior approach 24 25) . As mentioned, the higher rate of COPD in the control group could also have contributed to a higher infection rate 23) .…”

Section: Discussionmentioning

confidence: 99%

Intrawound Vancomycin Powder in Primary Total Hip Arthroplasty Increases Rate of Sterile Wound Complications

et al. 2018

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PurposeTotal hip arthroplasty (THA) is a successful surgery for the treatment of hip osteoarthritis; however, the risk of a post-operative prosthetic joint infection (PJI) remains at 1% to 2%. The purpose of this study was to investigate the safety profile of using vancomycin powder (VP) to reduce infection rates by reviewing acute postoperative complications.Materials and MethodsA retrospective review of 265 consecutive patients undergoing THA was performed. The first 128 patients, the control group, did not receive VP, and the subsequent 137 patients, the VP group, received VP at the time of wound closure. Patient demographic data, medical comorbidities, and perioperative information were compared.ResultsThe primary outcome was a post-operative surgical complication within 90 days from surgery. The control and VP group's demographic, medical comorbidities and perioperative information data were statistically similar. Deep infection rate in the control group was 5.5%, whereas the deep infection rate in the VP group was 0.7% (P=0.031). Sterile wound complication rate was 4.4% in the VP group, and 0% in the control group (P=0.030). Remaining complications were not statistically different between the groups.ConclusionVP was associated with an increase rate of sterile wound complications compared to the control group. The rate of PJI was decreased with the use of VP. We do not recommend for or against the use of VP at time of wound closure to prevent PJI, and higher powered studies will need to be performed to demonstrate the efficacy of VP.

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Section: Discussionmentioning

confidence: 99%

Intrawound Vancomycin Powder in Primary Total Hip Arthroplasty Increases Rate of Sterile Wound Complications

et al. 2018

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“…Compared with nonobese individuals, patients with a BMI over 30 have been reported to be at a 3.6 times greater risk for wound complications 6 and patients with a BMI over 35 were reported to have a seven times greater risk for developing a deep infection. 5 However, wound complications in obese patients may be independent of surgical approach, as wound complications were reported in 4.08% of DAA THAs and 4.04% of posterior approach THA patients with a BMI over 30. 6 Interestingly, of the four complications that occurred in the current study, three patients had a BMI under 20.4.…”

Section: Discussionmentioning

confidence: 99%

“…2,3 These complications are often related to the proximity of the surgical site to the inguinal region and increased friction due to excessive abdominal adipose tissue as found in patients with a high body mass index (BMI). 2,5,6 Previous researchers evaluating the DAA have reported a 3.6-fold increased risk for wound complications with a BMI greater than 30 6 and a sevenfold increased risk for deep infection in patients with a BMI greater than 35. 3 In addition to surgical technique and comorbidities, a few studies have evaluated the method of incision closure following THA as a possible risk factor for wound complications.…”

mentioning

confidence: 99%

Comparison of Wound Complications Between Two Closing Techniques Following Total Hip Arthroplasty Via the Direct Anterior Approach

et al. 2019

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A higher rate of wound complications has been reported in the direct anterior approach (DAA) for total hip arthroplasty (THA), reportedly due to the location of the incision and poor surgical site exposure techniques. Therefore, the purpose of this study was to compare wound complications within the first 90 days between a zipper closing method (ZM) and subcuticular monocryl with dermabond skin closure (SMD). A total of 294 patients (352 hips) were closed using the SMD and 166 patients (206 hips) were closed via the ZM. All THAs via the DAA and postoperative care were performed based on the current standard of care for the treatment of symptomatic hip osteoarthritis, established by a single, high volume surgeon from 2016 to 2018. Any wound complications during the first 90 days were noted. Independent t-tests determined differences in descriptive variables. Additionally, a Fisher Exact test was performed to compare wound complication rate between groups (p < 0.05). Surgical time was significantly shorter for ZM (p < 0.001) for both unilateral and bilateral groups compared with SMD. Overall, there were four complications occurring in 558 cases (0.7%), with two cases (0.36%) requiring additional surgery. No wound complications were present in the SMD and four wound complications (1.9%), two requiring surgery, were reported for the ZM (χ2 [1, N = 558] = 6.884, p = 0.009). While no wound complications were reported in the SMD group, the ZM group sustained four wound complications, two of which required additional surgery. Two of these wound complications occurred within the first 14 cases following implementation of the ZM, perhaps indicating a short learning curve. The ZM is a quicker, perhaps easier closure method yet the added expense for materials and suggested increased risk for wound complications may moderate the enthusiasm of the ZM compared with the sutures following THA via the DAA.

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“…For example, a corticosteroid injection received within 3 months before surgery predisposed patients undergoing total hip arthroplasty 37 and total knee arthroplasty 38 to PJI. The patient comorbidities of obesity [39][40][41][42][43] and psychiatric disorders 44 were associated with increased risk of PJI. Additionally, hypoalbuminemia was associated with increased PJI risk due to poor wound-healing 45,46 , and improving nutritional parameters, such as albumin, iron, protein, transferrin, vitamin D, and zinc, can reduce the risk of infection 47 .…”

Section: Shoulder and Elbowmentioning

confidence: 99%

What’s New in Musculoskeletal Infection: Update Across Orthopaedic Subspecialties

Chen

Nana²,

Nelson³

et al. 2017

The Journal of Bone and Joint Surgery

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Severely Obese Patients Have a Higher Risk of Infection After Direct Anterior Approach Total Hip Arthroplasty

Cited by 57 publications

References 17 publications

Intrawound Vancomycin Powder in Primary Total Hip Arthroplasty Increases Rate of Sterile Wound Complications

Intrawound Vancomycin Powder in Primary Total Hip Arthroplasty Increases Rate of Sterile Wound Complications

Comparison of Wound Complications Between Two Closing Techniques Following Total Hip Arthroplasty Via the Direct Anterior Approach

What’s New in Musculoskeletal Infection: Update Across Orthopaedic Subspecialties

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