Journal of Arthroplasty最新文献

Objective: Periprosthetic joint infections (PJI) remain a major complication in total joint arthroplasty. Tremendous efforts made intraoperatively to prevent PJI during primary procedures include antiseptics or antibiotics in irrigation solutions. This study analyzed the incidence of post-operative infection in relation to use of irrigation solutions and antibiotic powder.

Methods: We reviewed primary total hip arthroplasty (THA) and total knee arthroplasty (TKA) cases from the Michigan Arthroplasty Registry Collaborative Quality Initiative (MARCQI) between January 2019 and December 2022. Data on irrigation solutions were categorized by those containing antibiotics, chlorhexidine-gluconate (CHG), povidone-iodine, or other substances, compared to normal saline. Logistic regression analyses were conducted, adjusting for various factors such as age, body mass index (BMI), sex, American Society of Anesthesiologists (ASA) score, smoking, and more. There were 67,871 THA and 105,963 TKA cases analyzed, with an overall infection rate of 0.6% (CI [confidence interval]: 0.6 to 0.7, n = 420) for THA and 0.4% (0.36 to 0.43, n = 419) for TKA within 90 days post-surgery.

Results: There were statistical differences between the use of normal saline alone versus other irrigation solutions in THA, including povidone and others. For TKA, there was a statistically significant difference with lower infection rates using normal saline alone compared to multiple types, CHG, and povidone. Notably, the use of non-saline irrigation increased over the study period.

Conclusions: There was no reduction in 90-day infection rates for primary THA or TKA with irrigation additives. Higher infection rates were noted with povidone compared to saline for THA and TKA, potentially due to selection bias or local adverse tissue effects. Topical powders did not improve infection control. While irrigation is strongly recommended in all patients having TKA or THA, multiple irrigation solutions were not correlated with lower infection rates, suggesting importance of patient selection and optimization over irrigation type.

Introduction: Hemiarthroplasty (HA) is commonly performed in the setting of femoral neck fracture to allow for early mobilization. Fixation of the femoral component can be either press fit or cemented. The purpose of this study was to compare cemented and cementless hemiarthroplasty utilization and complications.

Methods: A multicenter retrospective analysis was performed on hip fracture patients from 2010 to 2019. The primary outcome of this study was revision due to periprosthetic fracture. Secondary outcomes included operative time, surgical complications, and mortality. Logistic regression was performed to compare the risk of various complications, adjusting for age, sex, body mass index, and comorbidity status.

Results: During this time period, cementless HA (577, 58.6%) was more commonly performed than cemented HA (407, 41.4%). There was a trend towards increasing cemented fixation over the study period (P < 0.001). Cementless HA patients were younger (77 versus 81, P < 0.001) and had shorter operative times (90.5 ± 35.7 versus 105.0 ± 38.7 minutes, P < 0.001). However, cementless HA patients were less likely to return to independent ambulation (8.2 versus 19.2%, P < 0.001), more likely to undergo revision surgery for periprosthetic fracture (2.6 versus 0.3%, P = 0.0035; OR [odds ratio] 11.06, 95% CI [confidence interval] 1.43 to 85.38), P = 0.021), and had higher dislocation rates (6.1 versus 2.7%, P = 0.014; OR 2.29 (CI 1.13 to 4.67), P = 0.022). Periprosthetic joint infection rates were comparable between groups (4.0 versus 4.9%, P = 0.48; OR 0.71 (CI 0.38 to 1.36), P = 0.31). The 90-day mortality was lower with cementless HA (10.8 versus 19.2%, P < 0.001), though mortality rates were comparable at the final follow-up (OR 1.23 (CI 0.94 to 1.62), P = 0.13).

Conclusion: The surgical complication risk of cementless hemiarthroplasty for femoral neck fracture is higher than cemented HA, with an 11-fold increased risk of periprosthetic fracture compared to cemented HA. Surgeons may consider routine use of cemented fixation for hemiarthroplasties performed for femoral neck fractures to mitigate the risk of fracture and need for further surgical intervention.