Subcutaneous Radiographic Measurement: A Marker to Evaluate Surgical Site Infection Risk in Elderly Hip Fracture Patients

Bernaus, Martí; Angles, Francesc; Escudero, Berta; Veloso, Margarita; Matamala, Alfredo; Font-Vizcarra, Lluís

doi:10.7150/jbji.30158

Cited by 8 publications

(25 citation statements)

References 22 publications

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“…Patients with an SRM greater than 60 mm had a 7-fold increase in the odds of APJI (OR = 7.42, 95 % CI = 3.01-18.28, p < 0.001) compared to those with smaller measurements. The reliability of measurements using this method between observers was previously corroborated by Bernaus et al (2019). The overall agreement between observers was good (intraclass correlation coefficient score = 0.822, 95 % CI: 0.754-0.873, p < 0.001).…”

Section: Discussionmentioning

confidence: 58%

“…Increased peritrochanteric soft-tissue thickness following primary total hip arthroplasty and its association with APJI has been barely studied. Bell et al (2019) performed a casecontrol study matched on age, sex, and BMI which did not demonstrate an association between radiographically measured peritrochanteric fat and infectious or wound complications following THA. They also performed the surgery using a posterior surgical approach.…”

Section: Discussionmentioning

confidence: 98%

“…A relationship between surgical site infection (SSI) and morbid obesity or diabetes has consistently been reported; although both conditions are often concurrent, both diabetes and morbid obesity independently contribute to SSI risk. Moreover, obesity has previously been demonstrated to be an independent risk factor for increased complications after total hip and knee arthroplasties (Dowsey and Choong, 2008;Ma et al, 2016;Chee et al, 2010;Zingg et al, 2016).…”

Section: Discussionmentioning

confidence: 99%

“…The impact of SRM in elderly patients with surgically treated hip fractures was previously studied (Bernaus et al, 2019). The analysis demonstrated an association between the SRM at the hip and the risk of SSI.…”

Section: Discussionmentioning

confidence: 99%

“…The objective of our study was to evaluate the association between acute periprosthetic joint infection (APJI) and softtissue thickness measured with an X-ray after elective total hip replacement surgery following the methodology previously described by Bernaus et al (2019).…”

Section: Introductionmentioning

confidence: 99%

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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.

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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.

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Section: Discussionmentioning

confidence: 58%

Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

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.

Self Cite

View full text Add to dashboard Cite

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

Sprowls

Allen

Wilson

et al. 2020

Baylor University Medical Center Proceedings

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The purpose of this study was to determine the relationship between soft tissue thickness lateral to the greater trochanter, as measured on anteroposterior pelvis radiograph, and postoperative complications following primary total hip arthroplasty. A retrospective review of 1110 consecutive patients treated at a single institution from 2003 to 2011 was conducted. Postoperative complications were divided into surgical site infections, deep wound infections, noninfectious surgical complications, need for revision surgery, and medical complications. Lateral soft tissue thickness (LSTT) was measured as the horizontal distance from the most lateral point on the greater trochanter to the skin edge obtained from anteroposterior hip radiographs. Among the 1110 study patients, 19.19% had a postoperative complication, with a deep infection rate of 3.42%. Of the previously identified risk factors, increased LSTT and body mass index were both associated with surgical site infection and deep infection, and LSTT was associated with revision surgery. An LSTT value of >5 cm was predictive of surgical site infection, deep infection, and revision surgery. This easily obtainable radiographic measurement, along with clinical examination near the operative site, might prove helpful in making preoperative risk assessments.

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Incision site fat thickness and 90-day complications for direct anterior and posterior approach total hip arthroplasty

et al. 2020

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Background: Defining the distribution of subcutaneous fat around the hip in relation to different approaches for total hip arthroplasty (THA) may lead to a better understanding of the relationship between obesity and complications. The purpose of this study was to: (1) describe the intraoperative thickness of subcutaneous fat at the incision site for direct anterior (DAA) and posterior approaches (PA) for THA; and (2) examine the relationship between fat thickness and 90-day postoperative complications. Methods: Intraoperative fat measurements were obtained at the anterior incision site (AT-IS) of the DAA ( n = 60) and the lateral incision site (LT-IS) of the PA ( n = 64). Lateral hip fat thickness was measured from preoperative anteroposterior pelvis radiographs (LT-XR). Body mass index (BMI), sex, age, and 90-day complications were collected retrospectively. Results: Patients within the same demographic groupings had significantly more fat laterally than anteriorly, between 9.6 mm and 17.96 mm. Return to the OR was significantly associated with BMI, AT-IS, and LT-IS. Wound complications were significantly associated with AT-IS. Periprosthetic joint infection (PJI) was significantly associated with BMI and LT-IS. No outcome variables were associated with LT-XR, approach, sex, or age. LT-XR was strongly correlated with AT-IS and LT-IS. Conclusions: Regardless of BMI, sex, or age more soft tissue was encountered with a PA compared to a DAA. General adiposity was associated with return to the OR. Excess incisional fat was associated with wound complications following a DAA and PJI after a PA. LT-XR and clinical examination near the proposed incision, may provide helpful data in making preoperative risk assessments.

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Subcutaneous Radiographic Measurement: A Marker to Evaluate Surgical Site Infection Risk in Elderly Hip Fracture Patients

Cited by 8 publications

References 22 publications

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

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

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

Incision site fat thickness and 90-day complications for direct anterior and posterior approach total hip arthroplasty

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