Olga L. Huk

Blood transfusion in primary total hip and knee arthroplasty. Incidence, risk factors, and thirty-day complication rates.

BACKGROUNDnThe aim of this study was to analyze NSQIP (National Surgical Quality Improvement Program) data to better understand the incidence, risk factors, and thirty-day complication rates associated with transfusions in primary total hip and knee arthroplasty.nnnMETHODSnWe identified 9362 total hip and 13,662 total knee arthroplasty procedures from the database and separated those in which any red blood-cell transfusion was performed within seventy-two hours after surgery from those with no transfusion. Patient demographics, comorbidities, preoperative laboratory values, intraoperative variables, and postoperative complications were compared between patients who received a transfusion and those who did not. Multivariate logistic regression was used to identify independent risk factors for receiving a transfusion as well as for associated postoperative complications (thirty-day incidences of infection, venous thromboembolism, and mortality).nnnRESULTSnThe transfusion rate after total hip arthroplasty was 22.2%. Significant risk factors for receiving a transfusion were age (OR [odds ratio] per ten years = 10.1), preoperative anemia (OR = 3.6), female sex (OR = 2.0), BMI (body mass index) of <30 kg/m(2) (OR = 1.4), and ASA (American Society of Anesthesiologists) class of >2 (OR = 1.3). Multivariate logistic regression analysis indicated that adjusted odds of infection, venous thromboembolism, and mortality did not differ significantly between patients who received a transfusion and those who did not. The transfusion rate after total knee arthroplasty was 18.3%. Risk factors for receiving a transfusion were age (OR per ten years = 10.2), preoperative anemia (OR = 3.8), BMI of <30 kg/m(2) (OR = 1.4), female sex (OR = 1.3), and ASA class of >2 (OR = 1.3). Multivariate logistic regression indicated that a transfusion was significantly associated with mortality (OR = 2.7) but not with infection or venous thromboembolism.nnnCONCLUSIONSnWe did not find a strong association between perioperative red blood-cell transfusion and thirty-day incidences of infection, venous thromboembolism, or mortality; however, the odds of mortality were higher in patients who received a transfusion during total knee arthroplasty.nnnLEVEL OF EVIDENCEnTherapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Stem-Sleeve Junction Failure of a Modular Femoral Hip System: a Retrieval Analysis

The use of a modular femoral hip system in total hip arthroplasty has increased in the last two decades. Modularity gives the surgeon the flexibility to adjust for excess femoral anteversion, offset and leg length and to restore the biomechanics of the hip joint independent of femoral fixation [3, 6, 20, 24, 36]. n nProximal femoral modularity includes neck-stem junctions and stem-sleeve junctions [37]. Previous reports have expressed concerns of fretting and corrosion damage at modular interfaces [3, 4, 6, 10, 26, 39, 40]. Modular component dissociation can occur in well-fixed components with disengagement of the trunnion during closed reduction of dislocated modular prostheses and also with subsidence of the femoral stem [1, 8, 28, 33, 35, 43]. Although uncommon, several reports have been published describing cases of fracture of the femoral stem at the neck-stem junction following total hip arthroplasty [12, 31, 32, 41, 44]. These mechanical failures occurred secondary to crevice corrosion, which created a microenvironment predisposing to fatigue fracture. While a few reports have been published documenting stem fracture within the stem-sleeve junctions [18, 25, 26], these reports lacked examination of patient- or implant-related factors that contributed to stem failure. In the present study, we report a case of an S-ROM® fracture (S-ROM®, DePuy Synthes, Warsaw, IN) within the modular sleeve in an adult female patient following a primary total hip arthroplasty. Systematic investigation and retrieval analysis were carried out to determine the underlying circumstances that contributed to the failure.The use of a modular femoral hip system in total hip arthroplasty has increased in the last two decades. Modularity gives the surgeon the flexibility to adjust for excess femoral anteversion, offset and leg length and to restore the biomechanics of the hip joint independent of femoral fixation [3, 6, 20, 24, 36]. Proximal femoral modularity includes neck-stem junctions and stem-sleeve junctions [37]. Previous reports have expressed concerns of fretting and corrosion damage at modular interfaces [3, 4, 6, 10, 26, 39, 40]. Modular component dissociation can occur in well-fixed components with disengagement of the trunnion during closed reduction of dislocated modular prostheses and also with subsidence of the femoral stem [1, 8, 28, 33, 35, 43]. Although uncommon, several reports have been published describing cases of fracture of the femoral stem at the neck-stem junction following total hip arthroplasty [12, 31, 32, 41, 44]. These mechanical failures occurred secondary to crevice corrosion, which created a microenvironment predisposing to fatigue fracture. While a few reports have been published documenting stem fracture within the stem-sleeve junctions [18, 25, 26], these reports lacked examination of patientor implant-related factors that contributed to stem failure. In the present study, we report a case of an S-ROM® fracture (SROM®, DePuy Synthes, Warsaw, IN) within the modular sleeve in an adult female patient following a primary total hip arthroplasty. Systematic investigation and retrieval analysis were carried out to determine the underlying circumstances that contributed to the failure.

Clinical and Radiological Outcome of the Newest Generation of Ceramic-on-Ceramic Hip Arthroplasty in Young Patients

Ceramic-on-ceramic articulations have become an attractive option for total hip arthroplasty in young patients. In this study, we retrospectively evaluated the short- to midterm clinical and radiographic results in 51 consecutive patients (61 hips) using the newest generation of ceramic implants. Results obtained in our study showed positive clinical and radiological outcomes. Both HHS and UCLA activity scores doubled after surgery and tended to increase over time. There was one infection requiring a two-stage revision and a case of squeaking that began 2 years postoperatively after a mechanical fall. The overall survival rate of the implants was 98.4% at six years with revision for any reason as the end point. Based on these results, fourth generation ceramics offer a viable option for young and active patients.