Arthroplasty Today最新文献_第6页

A Tribute to Greg J. Golladay, MD, FAOA: Big Shoes to Fill!

IF 1.5 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2025-02-01 DOI: 10.1016/j.artd.2025.101639

Brett R. Levine MD, MS (Editor-in-Chief)

引用次数: 0

A Contemporary Analysis of Discharge Disposition Following Total Joint Arthroplasty 全关节置换术后出院处置的当代分析。

IF 1.5 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2025-02-01 DOI: 10.1016/j.artd.2024.101592

Swaroopa Vaidya MS , Gregory Panza PhD , Jake Laverdiere BS , Dianne Vye MSN, RN, ONC , Jenna Bernstein MD

Background

Total joint arthroplasty (TJA) represents the single largest procedural cost for the Centers for Medicare & Medicaid Services. Discharge to a skilled nursing facility (SNF) remains a primary driver of post-acute care costs. The COVID-19 pandemic led to a decrease in number of discharges to SNFs. Examining preoperative patient characteristics of those who are still admitted to SNFs, despite cultural shifts, may help providers identify patients still at high risk for SNF discharge.

Methods

This retrospective study included patients who had elective total hip arthroplasty or total knee arthroplasty from January through December 2022 at a high-volume orthopaedic institute. Preoperative patient-reported outcome scores, demographics, and clinical characteristics were collected from patient charts and compared between patients who were discharged home vs SNF. Multivariate logistic regression analyses were used to determine potential predictors for discharge to SNF.

Results

In the total sample (N = 2795), 96.4% of patients were discharged home, and 3.6% were discharged to a SNF. Medicare insurance was associated with being discharged to a SNF (P < .05), while having commercial insurance was associated with being discharged home (P < .05). Being older, having longer procedure length, longer hospital length of stay, and a lower preoperative Patient-Reported Outcomes Measurement Information System (PROMIS 10) score were significant predictors of discharge to SNF (P < .05).

Conclusions

This was the first study to identify PROMIS 10 score as a potential predictor of discharge to a SNF after TJA. Findings from this study may help providers redefine contemporary predictors of SNF admission following TJA.

背景：全关节关节置换术（TJA）是美国医疗保险与医疗补助服务中心（Centers for Medicare & Medicaid Services）最大的一项手术费用。出院到专业护理机构（SNF）仍然是急性期后护理费用的主要驱动因素。COVID-19 大流行导致出院到专业护理机构的人数减少。尽管文化发生了转变，但研究那些仍被送往专业护理机构的患者的术前特征，可能有助于医疗服务提供者识别仍处于专业护理机构出院高风险的患者：这项回顾性研究纳入了 2022 年 1 月至 12 月期间在一家大医院骨科接受择期全髋关节置换术或全膝关节置换术的患者。研究人员从患者病历中收集了术前患者报告的结果评分、人口统计学特征和临床特征，并对出院回家与SNF患者进行了比较。多变量逻辑回归分析用于确定出院到SNF的潜在预测因素：在全部样本（N = 2795）中，96.4%的患者出院回家，3.6%的患者出院到SNF。医疗保险与出院后入住SNF有关（P < .05），而商业保险与出院后回家有关（P < .05）。年龄越大、手术时间越长、住院时间越长以及术前患者报告结果测量信息系统（PROMIS 10）评分越低，都是出院后转入SNF的重要预测因素（P < .05）：这是第一项将 PROMIS 10 评分确定为 TJA 术后出院转入 SNF 的潜在预测因素的研究。这项研究的结果可能有助于医疗服务提供者重新定义 TJA 术后入住 SNF 的当代预测因素。

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引用次数: 0

Intraprosthetic Dislocation Following Dual Mobility Total Hip Arthroplasty: A Retrieval Analysis Study 双活动全髋关节置换术后假体内脱位：一项检索分析研究。

IF 1.5 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2025-02-01 DOI: 10.1016/j.artd.2024.101596

Salar Sobhi BSc, MD , Alan Kop MSc, PhD , Moreica Pabbruwe PhD , Christopher W. Jones BCom, BEng(Hons), MBBS(Hons), PhD, FRACS, FAOrthA , Michael A. Finsterwald MD, FMH, FRACS, FAOrthA

Background

Dual mobility (DM) implants in total hip arthroplasty provide excellent range of motion with low dislocation rates. A complication of this design is intraprosthetic dislocation (IPD), where the polyethylene (PE) liner dissociates from the femoral head. In older designs, IPD occurred due to a small head size and late PE wear with head-capture-mechanism failure. Routine retrieval analysis identified concerns regarding IPD of modern implants, and scant reporting in the literature led to this retrospective study.

Methods

A total of 124 (110 primary, 14 revision) DM implants (mean in situ time 2.0 ± 3.1 years) revised by 20 surgeons across Western Australia between July 2014 and August 2023 were assessed. Demographics, clinical information, mechanisms of failure, and observations at revision arthroplasty were analyzed. The retrieval analysis included an assessment of metal and PE wear mechanisms, corrosion between modular components, and extent of bony attachment to acetabular shells.

Results

There were 11 cases of IPD. Of these, 8 (73%) had a documented preceding failed closed reduction, with the remaining 3 revised due to trunnionosis, loosening, and joint instability. Nine out of 11 (82%) cases were female. Although metallic wear and inner-lip impingement of PE bearings were observed, there was no obvious failure mechanism for the other 3 retrieved IPD implants.

Conclusions

Most cases of IPD in DM implants occur after failed closed reduction in the setting of a hip dislocation, suggesting an iatrogenic cause of IPD. No implant-related features could be defined for the remaining cases. Recognizing common failure modes can help with the prevention and treatment of this complication.

背景：双活动（DM）假体在全髋关节置换术中提供良好的活动范围和低脱位率。这种设计的一个并发症是假体内脱位（IPD），聚乙烯（PE）衬垫与股骨头分离。在较早的设计中，IPD的发生是由于头部尺寸小和后期PE磨损以及头部捕获机制失效。常规检索分析确定了对现代植入物IPD的关注，文献报道不足导致了这项回顾性研究。方法：对2014年7月至2023年8月期间由西澳大利亚州20名外科医生翻修的124例（110例原发性，14例翻修）DM种植体（平均原位时间2.0±3.1年）进行评估。分析了人口统计学、临床信息、失败机制和关节置换术的观察结果。检索分析包括评估金属和PE磨损机制，模块组件之间的腐蚀以及骨附着到髋臼壳的程度。结果：11例IPD。其中，8例（73%）患者先前有记录的闭合复位失败，其余3例因耳膜萎缩、松动和关节不稳定而进行了复位。11例中有9例（82%）为女性。虽然观察到PE轴承的金属磨损和内唇撞击，但其他3个回收的IPD种植体没有明显的失效机制。结论：大多数DM植入物的IPD发生在髋关节脱位闭合复位失败后，提示IPD的医源性原因。其余病例无植入物相关特征。认识常见的失效模式有助于预防和治疗这种并发症。

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引用次数: 0

Optimizing Operating Room Efficiency for Primary Hip and Knee Arthroplasty Using Performance Benchmarks 使用性能基准优化初级髋关节和膝关节置换术的手术室效率。

IF 1.5 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2025-02-01 DOI: 10.1016/j.artd.2024.101590

Koorosh Kashanian BMSc , Matey Juric BSc , Tim Ramsay PhD , Pascal Fallavollita PhD , Paul E. Beaulé MD, FAAOS, FRCSC

Background

With increasing demand for total hip arthroplasty (THA) and total knee arthroplasty (TKA), maximizing operating room (OR) efficiency is critical. This paper sought to examine the implementation of time benchmarks when performing primary TKA and THA. We hypothesized that implementing benchmarks would improve efficiency and the number of joints performed per day.

Methods

Two hundred ninety-five patients from 59 OR days were reviewed. All surgeries were performed as outpatients and included 160 females and 135 males; 161 TKA and 134 THA; mean age, 66.1; mean body mass index, 28.6 kg/m²; American Society of Anesthesia, 2. Time points, demographics, and adverse events were recorded. Benchmarks to complete 4 joints in 8 h were: anesthesia preparation time (APT) of <11 min, procedure time of <72 min, anesthesia finish time (AFT) of <21 min, and turnover of <22 min.

Results

The percentage of cases meeting individual benchmarks for APT was 50.17%; procedure time was 95.25%; AFT was 99.67%; turnover was 65.25%. The means were: APT 11:00 min, Surgical Prep Time 9:00 min, procedure time 55:00 min, AFT 3:00 min, and turnover 19:00 min. Overall, 98.3% (58/59) of ORs had 4 cases completed within 8 h and 52.5% (31/59) had 5 cases within 8 h. Age, body mass index, and consecutive laterality of surgery were determined to affect the likelihood of meeting benchmarks for case time, APT, and turnover.

Conclusions

Establishing time benchmarks permitted the introduction of 5 joint days within an 8-h OR without increasing resource utilization. Factors that influence OR efficiency for high-volume primary hip and knee replacements were identified.

背景：随着全髋关节置换术（THA）和全膝关节置换术（TKA）需求的增加，手术室（OR）效率的最大化是至关重要的。本文试图检查执行主要TKA和THA时的时间基准的实施。我们假设实现基准将提高效率和每天执行的关节数量。方法：回顾性分析住院59天295例患者的临床资料。所有手术均为门诊患者，包括160名女性和135名男性；TKA 161个，THA 134个；平均年龄66.1岁；平均体重指数28.6 kg/m2；美国麻醉学会，2。记录时间点、人口统计数据和不良事件。8 h内完成4个关节的基准为：麻醉准备时间（APT）的结果：达到个体APT基准的病例占50.17%；手术时间为95.25%；AFT为99.67%；流动率65.25%。平均时间为：手术时间11:00 min，手术准备时间9:00 min，手术时间55:00 min，手术时间3:00 min，手术时间19:00 min。总体而言，98.3%（58/59）的手术室在8小时内完成4例，52.5%（31/59）的手术室在8小时内完成5例。确定年龄，体重指数和连续手术侧侧影响达到病例时间，APT和手术时间基准的可能性。结论：建立时间基准可以在不增加资源利用率的情况下，在8小时的手术室内引入5个联合天。确定了影响大容量原发性髋关节和膝关节置换术OR效率的因素。

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引用次数: 0

Patient “No-Show” Prior to Elective Primary Total Hip Arthroplasty Increases Risk of Postoperative Anemia

IF 1.5 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2025-02-01 DOI: 10.1016/j.artd.2024.101602

Jeffrey S. Mun BA , Matthew W. Parry MD, MS , Alex Tang MD , Jesse J. Manikowski MS , Cory Crinella PA-C , John J. Mercuri MD, MA

Background

Patients who “no-show” (NS) clinical appointments are at a higher risk of poor healthcare outcomes. The objective of this study was to evaluate and characterize the relationship between patient NS prior to primary total hip arthroplasty (THA) and 90-day complication risk after THA.

Methods

We retrospectively reviewed 4147 patients undergoing primary THA. Patients were divided based on whether they NS at least 1 appointment vs always attend (AA) appointments. Information collected included number of NS and attended appointments, demographics, comorbidities, and 90-day postoperative complications. Regression analyses were run to identify relationships between NS status and postoperative outcomes, as well as factors that would predict NS status.

Results

Compared to AA patients, NS patients had an increased odds of a postoperative complication (odds ratio:1.3, P = .0005), specifically postoperative anemia (odds ratio: 1.3, P = .0004). When comparing NS and AA patients who both experienced postoperative anemia-related complications, the NS patients had significantly greater intraoperative blood loss compared to AA patients (mean ± standard deviation: 412.6 mL ± 310.2 vs 357.3 mL ± 269.0, P = .028). NS patients also had a greater rate of symptomatic anemia compared to AA patients (100 [3%] vs 25 cases [2%], P = .018). Age, smoking status, gender, race, body mass index, Charlson Comorbidity Index, and insurance status were independent predictors of missing clinical appointments.

Conclusions

There was an increased risk for complications, specifically anemia-related complications, in THA patients who NS preoperatively. Demographic factors were independently associated with higher odds of missing a scheduled clinical appointment. The results suggest orthopedic surgeons should consider NS data to pre-emptively assess risk for complications following THA.

Level of Evidence

Level III.

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引用次数: 0

Robotic Assistance in Simultaneous Bilateral Medial Unicompartmental Knee Arthroplasty: A Retrospective Cohort Study of 126 Knees Demonstrating Enhanced Radiographic Accuracy and Comparable Safety to Conventional Methods

IF 1.5 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2025-02-01 DOI: 10.1016/j.artd.2024.101594

Valentina Rossi MD , Constant Foissey MD , Andreas Fontalis MD, MSc, MRCS , Gabriel Gaggiotti MD , Stefano Gaggiotti MD , Elvire Servien MD, PhD , Sébastien Lustig MD, PhD

Background

One-stage bilateral unicompartmental knee arthroplasty (BUKA) is a promising option for patients with bilateral medial knee osteoarthritis. This study aims to compare the safety, early clinical and functional outcomes, and radiological results of conventional vs robotic-assisted medial BUKA.

Methods

A retrospective cohort study was conducted involving patients who underwent medial BUKA as a single-stage procedure between April 2016 and January 2022. The study included both conventional (36 procedures) and robotic-assisted techniques (90 procedures) with a minimum follow-up of 6 months. Conventional procedures were performed either simultaneously by two surgical teams or sequentially by one team. Robotic procedures were exclusively performed sequentially by a single team. Data on surgical outcomes, patient-reported outcome measures (International Knee Society score), and radiographic measurements were collected.

Results

Among the 63 patients analyzed, robotic-assisted procedures took significantly longer (115 ± 22 minutes) compared to conventional approaches (86.9 ± 12 minutes; P < .0001). No significant differences were observed in complications, length of hospital stay, rehospitalizations, patient-reported outcome measures, or overall clinical outcomes. However, radiographic analysis showed superior joint line restoration in the robotic group (−0.2 ± 0.7 mm vs −1.4 ± 1.35 mm, P = .03) and better tibial implant varus control (0.3° ± 0.6 vs 1° ± 1.8 degrees, P = .03).

Conclusions

While robotic-assisted BUKA resulted in longer operative times, clinical outcomes were comparable. Radiographic findings indicated improved implant positioning, suggesting potential benefits in implantation accuracy that warrant further research.

Level of Evidence

IV.

{"title":"Robotic Assistance in Simultaneous Bilateral Medial Unicompartmental Knee Arthroplasty: A Retrospective Cohort Study of 126 Knees Demonstrating Enhanced Radiographic Accuracy and Comparable Safety to Conventional Methods","authors":"Valentina Rossi MD , Constant Foissey MD , Andreas Fontalis MD, MSc, MRCS , Gabriel Gaggiotti MD , Stefano Gaggiotti MD , Elvire Servien MD, PhD , Sébastien Lustig MD, PhD","doi":"10.1016/j.artd.2024.101594","DOIUrl":"10.1016/j.artd.2024.101594","url":null,"abstract":"<div><h3>Background</h3><div>One-stage bilateral unicompartmental knee arthroplasty (BUKA) is a promising option for patients with bilateral medial knee osteoarthritis. This study aims to compare the safety, early clinical and functional outcomes, and radiological results of conventional vs robotic-assisted medial BUKA.</div></div><div><h3>Methods</h3><div>A retrospective cohort study was conducted involving patients who underwent medial BUKA as a single-stage procedure between April 2016 and January 2022. The study included both conventional (36 procedures) and robotic-assisted techniques (90 procedures) with a minimum follow-up of 6 months. Conventional procedures were performed either simultaneously by two surgical teams or sequentially by one team. Robotic procedures were exclusively performed sequentially by a single team. Data on surgical outcomes, patient-reported outcome measures (International Knee Society score), and radiographic measurements were collected.</div></div><div><h3>Results</h3><div>Among the 63 patients analyzed, robotic-assisted procedures took significantly longer (115 ± 22 minutes) compared to conventional approaches (86.9 ± 12 minutes; <em>P</em> < .0001). No significant differences were observed in complications, length of hospital stay, rehospitalizations, patient-reported outcome measures, or overall clinical outcomes. However, radiographic analysis showed superior joint line restoration in the robotic group (−0.2 ± 0.7 mm vs −1.4 ± 1.35 mm, <em>P</em> = .03) and better tibial implant varus control (0.3° ± 0.6 vs 1° ± 1.8 degrees, <em>P</em> = .03).</div></div><div><h3>Conclusions</h3><div>While robotic-assisted BUKA resulted in longer operative times, clinical outcomes were comparable. Radiographic findings indicated improved implant positioning, suggesting potential benefits in implantation accuracy that warrant further research.</div></div><div><h3>Level of Evidence</h3><div>IV.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"31 ","pages":"Article 101594"},"PeriodicalIF":1.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11788786/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143123847","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Validation of a Novel Landmark-guided Intra-articular Postero-medial Surgeon-administered Injection Technique

IF 1.5 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2025-02-01 DOI: 10.1016/j.artd.2025.101619

Nicolas S. Piuzzi MD , Andrew I. Spitzer MD , Jason Mussell PhD , Ignacio Pasqualini MD , Stan Dysart MD , Jeffrey Gonzales MD , Michael A. Mont MD , Jess H. Lonner MD , William Mihalko MD, PhD

Background

This study aimed to define an intra-articular surgeon-administered technique that may be comparable to ultrasound (US)-guided adductor canal block (ACB).

Methods

Five cadaver lower limbs were examined. An anesthesiologist administered a US-guided ACB using 20 mL of dilute indocyanine dye. An orthopedic surgeon performed a medial parapatellar arthrotomy and introduced an 18-gauge needle 1-2 cm proximal to the palpated adductor tubercle angled posteromedially. Needle position and dye spread were fluoroscopically documented.

Results

This technique consistently reached the infrapatellar branch of the saphenous nerve, nerve to the vastus medialis muscle, and posterior capsule, with minimal proximal dye spread.

Conclusions

This technique may be an efficient complement to ACB or surgeon infiltration or an alternative to US-guided ACB when it is not available.

{"title":"Validation of a Novel Landmark-guided Intra-articular Postero-medial Surgeon-administered Injection Technique","authors":"Nicolas S. Piuzzi MD , Andrew I. Spitzer MD , Jason Mussell PhD , Ignacio Pasqualini MD , Stan Dysart MD , Jeffrey Gonzales MD , Michael A. Mont MD , Jess H. Lonner MD , William Mihalko MD, PhD","doi":"10.1016/j.artd.2025.101619","DOIUrl":"10.1016/j.artd.2025.101619","url":null,"abstract":"<div><h3>Background</h3><div>This study aimed to define an intra-articular surgeon-administered technique that may be comparable to ultrasound (US)-guided adductor canal block (ACB).</div></div><div><h3>Methods</h3><div>Five cadaver lower limbs were examined. An anesthesiologist administered a US-guided ACB using 20 mL of dilute indocyanine dye. An orthopedic surgeon performed a medial parapatellar arthrotomy and introduced an 18-gauge needle 1-2 cm proximal to the palpated adductor tubercle angled posteromedially. Needle position and dye spread were fluoroscopically documented.</div></div><div><h3>Results</h3><div>This technique consistently reached the infrapatellar branch of the saphenous nerve, nerve to the vastus medialis muscle, and posterior capsule, with minimal proximal dye spread.</div></div><div><h3>Conclusions</h3><div>This technique may be an efficient complement to ACB or surgeon infiltration or an alternative to US-guided ACB when it is not available.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"31 ","pages":"Article 101619"},"PeriodicalIF":1.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143162547","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Keeping the Momentum Going

IF 1.5 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2025-02-01 DOI: 10.1016/j.artd.2025.101638

Brett R. Levine MD, MS (Editor-in-Chief)

引用次数: 0

Hospital Financial Burden of Surgical Procedures for Periprosthetic Total Hip Arthroplasty Infection

IF 1.5 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2025-02-01 DOI: 10.1016/j.artd.2024.101609

Jesus M. Villa MD, Tejbir S. Pannu MD, MS, Robert B. Eysler BA, Vivek Singh MD, MPH, Alison K. Klika MS, Carlos A. Higuera MD

Background

For reimbursement purposes, current coding fails to reflect the true complexity and resource utilization of hospital encounters for surgeries performed to treat periprosthetic total hip arthroplasty (THA) infection. Therefore, when compared to aseptic revisions, we sought to determine (1) Is length of stay (LOS) longer for septic surgeries? (2) Are septic procedures more expensive? and (3) How do different surgical procedures for infection compare with aseptic revisions on hospital LOS and charges?

Methods

Retrospective chart review of 596 unilateral THA reoperations (473 patients) performed at a single institution (January 2015 to November 2020). Demographics, professional (ie, physicians), and technical (ie, room, implants) hospital charges per case were compared between 6 different surgery types: (1) aseptic revision (control; n = 364); (2) debridement, antibiotics, and implant retention (n = 11); (3) explantation (n = 145); (4) spacer exchange (n = 7); (5) 2-stage reimplantation (n = 59); and (6) 1-stage reimplantation (n = 10).

Results

Overall, septic surgeries (n = 232) had longer LOS (mean 6.3 vs 3.3 days, P < .001) and 43% higher total charges (P < .001), vs aseptic revisions. Particularly, explantations had longer LOS (7.1 vs 3.3 days) and 56% higher total charges (both P < .001). When compared to aseptic revisions, proportional total charges for septic procedures were debridement, antibiotics, and implant retention +29%, P = .4; explantation +56%, P < .001; spacer exchange +69%, P = .008; 2-stage reimplantation +11%, P = .659; and 1-stage reimplantation +46%, P = .06.

Conclusions

Some surgical procedures performed to treat periprosthetic THA infection are associated with longer LOS and significantly higher hospital charges when compared to aseptic revisions. Reimbursement adjustment is needed as current coding for septic reoperations does not reflect actual hospital resource consumption and this situation may limit access to patient care.

{"title":"Hospital Financial Burden of Surgical Procedures for Periprosthetic Total Hip Arthroplasty Infection","authors":"Jesus M. Villa MD, Tejbir S. Pannu MD, MS, Robert B. Eysler BA, Vivek Singh MD, MPH, Alison K. Klika MS, Carlos A. Higuera MD","doi":"10.1016/j.artd.2024.101609","DOIUrl":"10.1016/j.artd.2024.101609","url":null,"abstract":"<div><h3>Background</h3><div>For reimbursement purposes, current coding fails to reflect the true complexity and resource utilization of hospital encounters for surgeries performed to treat periprosthetic total hip arthroplasty (THA) infection. Therefore, when compared to aseptic revisions, we sought to determine (1) Is length of stay (LOS) longer for septic surgeries? (2) Are septic procedures more expensive? and (3) How do different surgical procedures for infection compare with aseptic revisions on hospital LOS and charges?</div></div><div><h3>Methods</h3><div>Retrospective chart review of 596 unilateral THA reoperations (473 patients) performed at a single institution (January 2015 to November 2020). Demographics, professional (ie, physicians), and technical (ie, room, implants) hospital charges per case were compared between 6 different surgery types: (1) aseptic revision (control; n = 364); (2) debridement, antibiotics, and implant retention (n = 11); (3) explantation (n = 145); (4) spacer exchange (n = 7); (5) 2-stage reimplantation (n = 59); and (6) 1-stage reimplantation (n = 10).</div></div><div><h3>Results</h3><div>Overall, septic surgeries (n = 232) had longer LOS (mean 6.3 vs 3.3 days, <em>P</em> < .001) and 43% higher total charges (<em>P</em> < .001), vs aseptic revisions. Particularly, explantations had longer LOS (7.1 vs 3.3 days) and 56% higher total charges (both <em>P</em> < .001). When compared to aseptic revisions, proportional total charges for septic procedures were debridement, antibiotics, and implant retention +29%, <em>P</em> = .4; explantation +56%, <em>P</em> < .001; spacer exchange +69%, <em>P</em> = .008; 2-stage reimplantation +11%, <em>P</em> = .659; and 1-stage reimplantation +46%, <em>P</em> = .06.</div></div><div><h3>Conclusions</h3><div>Some surgical procedures performed to treat periprosthetic THA infection are associated with longer LOS and significantly higher hospital charges when compared to aseptic revisions. Reimbursement adjustment is needed as current coding for septic reoperations does not reflect actual hospital resource consumption and this situation may limit access to patient care.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"31 ","pages":"Article 101609"},"PeriodicalIF":1.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11780107/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143068436","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Exploring Acute Kidney Injury Incidence in Hip Periprosthetic Joint Infection Treatment With Combined Intravenous and Intra-articular Antibiotic Infusion

IF 1.5 Q3 ORTHOPEDICS

Arthroplasty Today

Pub Date : 2025-02-01 DOI: 10.1016/j.artd.2025.101616

Wenbo Mu MD, PhD , Boyong Xu MD , Fei Wang MD , Wentao Guo MD, PhD , Xiaogang Zhang MD , Li Cao MD

Background

Periprosthetic joint infections (PJIs) are a significant complication following total hip arthroplasty, impacting patient health and healthcare costs. This study examines the incidence of acute kidney injury (AKI) in patients undergoing hip PJI treatment with a combination of intravenous and intra-articular antibiotic infusion therapies.

Methods

A retrospective review of 151 patient records from May 1, 2010 to December 30, 2022 was conducted at a single academic hospital. Patients were treated for hip PJIs using debridement, antibiotics, and implant retention or single-stage revision surgeries. AKI was classified according to the Kidney Disease: Improving Global Outcomes criteria.

Results

Among 151 patients, 17 (11.26%) developed AKI, with 13 cases resolving transiently before discharge. The median onset of AKI was on postoperative day 2, with stage I AKI being the most prevalent, accounting for 64.71% of cases. Diabetes and low baseline serum creatinine levels were identified as independent risk factors for AKI, with odds ratios of 9.69 and 1.09, respectively.

Conclusions

The combined regimen of intra-articular and intravenous antibiotic infusion appears to have a manageable risk profile regarding AKI. This approach could serve as a viable alternative for PJI management, emphasizing the importance of careful patient monitoring and tailored antibiotic regimens. Further studies are recommended to optimize treatment protocols and mitigate risks.

{"title":"Exploring Acute Kidney Injury Incidence in Hip Periprosthetic Joint Infection Treatment With Combined Intravenous and Intra-articular Antibiotic Infusion","authors":"Wenbo Mu MD, PhD , Boyong Xu MD , Fei Wang MD , Wentao Guo MD, PhD , Xiaogang Zhang MD , Li Cao MD","doi":"10.1016/j.artd.2025.101616","DOIUrl":"10.1016/j.artd.2025.101616","url":null,"abstract":"<div><h3>Background</h3><div>Periprosthetic joint infections (PJIs) are a significant complication following total hip arthroplasty, impacting patient health and healthcare costs. This study examines the incidence of acute kidney injury (AKI) in patients undergoing hip PJI treatment with a combination of intravenous and intra-articular antibiotic infusion therapies.</div></div><div><h3>Methods</h3><div>A retrospective review of 151 patient records from May 1, 2010 to December 30, 2022 was conducted at a single academic hospital. Patients were treated for hip PJIs using debridement, antibiotics, and implant retention or single-stage revision surgeries. AKI was classified according to the Kidney Disease: Improving Global Outcomes criteria.</div></div><div><h3>Results</h3><div>Among 151 patients, 17 (11.26%) developed AKI, with 13 cases resolving transiently before discharge. The median onset of AKI was on postoperative day 2, with stage I AKI being the most prevalent, accounting for 64.71% of cases. Diabetes and low baseline serum creatinine levels were identified as independent risk factors for AKI, with odds ratios of 9.69 and 1.09, respectively.</div></div><div><h3>Conclusions</h3><div>The combined regimen of intra-articular and intravenous antibiotic infusion appears to have a manageable risk profile regarding AKI. This approach could serve as a viable alternative for PJI management, emphasizing the importance of careful patient monitoring and tailored antibiotic regimens. Further studies are recommended to optimize treatment protocols and mitigate risks.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"31 ","pages":"Article 101616"},"PeriodicalIF":1.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143162546","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0