1
|
Revelt N, Sleiman A, Kurcz B, George E, Kleinsmith R, Feibel B, Thuppal S, Delfino K, Allan DG. Acute Surgical Site Complications in Direct Anterior Total Hip Arthroplasty: Impact of Local Subcutaneous Tissue Depth and Body Mass Index. Arthroplast Today 2024; 28:101465. [PMID: 39100419 PMCID: PMC11295467 DOI: 10.1016/j.artd.2024.101465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 04/27/2024] [Accepted: 06/09/2024] [Indexed: 08/06/2024] Open
Abstract
Background Body mass index (BMI) is an imperfect measure of patients' adiposity and operative risk. Radiographic and direct subcutaneous measurements have been utilized in attempts to more accurately characterize the risk of postoperative complications, including surgical site infection. This study aims to evaluate whether direct tissue depth measurement is a more accurate predictor of skin complication following direct anterior total hip arthroplasty (THA). Methods A retrospective chart review of patients who underwent elective THA between April 30, 2020, and January 31, 2023, was performed. Baseline demographics, antibiotics, anticoagulation, and intraoperatively measured tissue depths at proximal, middle, and distal portions of the incision were recorded. Patient follow-up was reviewed to assess the development of skin complication in the acute postoperative period. Results Data were collected from 280 patients who underwent THA via direct anterior approach by a single surgeon. The mean age was 66.0 years, and 52.1% were female. A total of 18/280 (6.4%) patients developed an abrasion (5/18) or superficial surgical site infection (13/18) within the first 60 days postoperatively. Patients who developed skin complications had a significantly higher BMI (33.7 kg/m2 vs 29.9 kg/m2; P = .0021). Patients with a BMI >30 kg/m2 had more than 5 times increased odds of developing a superficial skin complication in the acute 60-day postoperative period compared to those with a BMI <30 kg/m2 (Odds ratio = 5.318, P = .0059). None of the measured tissue depths, nor their average together, were shown to be significant predictors of skin complications. Conclusions This study showed that BMI is a significant predictor of acute skin complications in direct anterior THA patients. No other significant predictors were found to be associated with increased risk, including proximal, middle, and distal tissue depths.
Collapse
Affiliation(s)
- Nicolas Revelt
- Division of Orthopaedics and Rehabilitation, Department of Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Anthony Sleiman
- Division of Orthopaedics and Rehabilitation, Department of Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA
- Center for Clinical Research, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Brian Kurcz
- Cincinnati Sports Medicine & Orthopaedic Center, Cincinnati, OH
- Mercy Health, Cincinnati, OH, USA
| | - Edgar George
- Southern Illinois University School of Medicine, Springfield, IL
| | | | - Benjamin Feibel
- Division of Orthopaedics and Rehabilitation, Department of Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Sowmyanarayanan Thuppal
- Division of Orthopaedics and Rehabilitation, Department of Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA
- Center for Clinical Research, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Kristin Delfino
- Center for Clinical Research, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - D. Gordon Allan
- Division of Orthopaedics and Rehabilitation, Department of Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA
| |
Collapse
|
2
|
Godziuk K, Fast A, Righolt CH, Giori NJ, Harris AHS, Bohm ER. Consistent Factors Influence Body Mass Index Thresholds for Total Joint Arthroplasty Across Health-Care Systems: A Qualitative Study. J Bone Joint Surg Am 2024; 106:1076-1090. [PMID: 38704647 DOI: 10.2106/jbjs.23.01081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/06/2024]
Abstract
BACKGROUND Body mass index (BMI) thresholds are used as eligibility criteria to reduce complication risk in total joint arthroplasty (TJA). This approach oversimplifies preoperative risk assessment and inadvertently restricts access to effective surgical treatment for osteoarthritis. A prior survey of orthopaedic surgeons in the United States identified complex underlying factors that influence BMI considerations. To understand whether similar factors exist and influence surgeons in a different health-care system setting, we investigated Canadian surgeons' views and use of BMI criterion thresholds for TJA access. METHODS A cross-sectional online qualitative survey was conducted with orthopaedic surgeons performing TJA in the Canadian health-care system. Responses were anonymous and questions were open-ended to allow for candid perspectives. Survey data were coded and a systematic process was followed to identify major themes. Findings were compared with U.S. surgeon perspectives. RESULTS Sixty-nine respondents had a mean age of 49.0 ± 11.4 years (range, 33 to 79 years), with a mean surgical experience duration of 15.7 ± 11.4 years (range, 2 to 50 years). Surgeons reported variable use of BMI thresholds in practice. Twelve interconnected factors that influence BMI considerations were identified: (1) variable evidence interpretation, (2) surgical challenge, (3) surgeon beliefs and biases, (4) hospital differences, (5) access to resources, (6) health system bias, (7) patient health status, (8) patient body fat distribution, (9) patient decisional burden (to lose weight or accept risk), (10) evidence gaps and uncertainties, (11) need for innovation, and (12) societal views. Nine themes matched with findings from U.S. surgeons. CONCLUSIONS Parallel to the United States, complex, interconnected factors influence Canadian orthopaedic surgeons' variable use of BMI restrictions for TJA eligibility. Despite different health-care systems and reimbursement models, similar technical and personal factors were identified. With TJA practice guidelines advising against hard BMI criteria, attention regarding access to resources, surgical training, and innovations to address TJA complexity in patients with large bodies are critically needed. Future advancements in this sphere must balance barrier removal with risk reduction to ensure safe and equitable surgical care. CLINICAL RELEVANCE This study may influence surgeon behaviors with regard to hard BMI cutoffs for TJA and encourage critical thought about factors that influence decisions about surgical eligibility for patients with high BMI.
Collapse
Affiliation(s)
- Kristine Godziuk
- Department of Agricultural, Food and Nutritional Science, Faculty of Agricultural, Life and Environmental Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Andrew Fast
- Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Christiaan H Righolt
- Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
- Orthopaedic Innovation Centre, Winnipeg, Manitoba, Canada
| | - Nicholas J Giori
- Department of Orthopedic Surgery, School of Medicine, Stanford University, Stanford, California
- VA Palo Alto Health Care System, Palo Alto, California
| | - Alex H S Harris
- Department of Surgery, School of Medicine, Stanford University
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, California
| | - Eric R Bohm
- Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
- Orthopaedic Innovation Centre, Winnipeg, Manitoba, Canada
| |
Collapse
|
3
|
Parikh S, Pannu TS, Davis T, Gomez O, Corces A. Local Soft-Tissue Thickness vs. Body Mass Index as Predictors of Complications After Total Knee or Hip Arthroplasty: A Literature Review. JBJS Rev 2023; 11:01874474-202311000-00009. [PMID: 38016004 DOI: 10.2106/jbjs.rvw.22.00128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
» Body mass index (BMI) is a nonspecific measure of general fat composition that demonstrates little conclusive or definitive association with surgical site complications after total knee and total hip arthroplasty.» Quantifying soft-tissue thickness (STT) around the joint of interest has shown positive correlations with complications and is arguably a better predictor than BMI.» In this literature review, 14 articles (7 discussing hips and 7 discussing knees) discussing the association of STT, BMI, and surgical site complications after total hip and knee arthroplasty were scrutinized and summarized to present relevant information necessary to compare STT with BMI.» Five of the 7 studies involving hips and 4 of the 7 studies involving knees show a positive relationship between STT and outcomes including complications and infection, with some claiming STT as a stronger predictor of surgery site problems than BMI.» Since many variables, such as STT measurement technique, surgical outcomes, sample sizes, and surgical approach, varied between the studies, definitive inferences are difficult to make and future studies of bigger sample size and higher power should focus on the described measurement techniques.
Collapse
Affiliation(s)
- Sarthak Parikh
- Department of Orthopaedic Surgery, Larkin Community Hospital, South Miami, Florida
| | | | | | | | | |
Collapse
|
4
|
Heifner JJ, Fox YM, Sakalian PA, Corces A. The use of local adiposity as a proxy for obesity in primary total hip arthroplasty: A systematic review. J Orthop 2023; 38:79-84. [PMID: 37025554 PMCID: PMC10070364 DOI: 10.1016/j.jor.2023.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 03/23/2023] [Accepted: 03/25/2023] [Indexed: 04/08/2023] Open
Abstract
Introduction Preoperative optimization of obese patients is a critical component of risk stratification in primary total hip arthroplasty (THA). Body mass index is ubiquitously utilized as a proxy for obesity due to its ease of attainment and simplistic interpretation. The use of adiposity as a proxy for obesity is an emerging concept. Local adiposity provides insight into the magnitude of peri-incisional tissue and has demonstrated an association with postoperative complications. Our objective was to review the literature to determine if local adiposity is a reliable predictor for complications following primary total hip arthroplasty. Methods In keeping with the PRISMA guidelines, a database search of PubMed was conducted for articles which reported on the relationship between quantified measures of adiposity at the hip and rates of complication following primary THA. Methodological quality was assessed using GRADE and risk of bias using ROBINS-I. Results A total of six articles (N = 2931) met the inclusion criteria. Local adiposity at the hip was measured on anteroposterior radiograph in four articles and was measured intraoperatively in two. Across four of the six articles, adiposity was significantly associated with postoperative complications including prosthesis failure and infection. Conclusion The use of BMI as a predictor for postoperative complication has been fraught with inconsistency. There is momentum for adiposity to be used as a proxy for obesity in preoperative THA risk stratification. The current findings demonstrated that local adiposity may be a reliable predictor for complications following primary THA.
Collapse
Affiliation(s)
- John J. Heifner
- Miami Orthopaedic Research Foundation, Coral Gables, FL, USA
| | - Yitzak M. Fox
- Larkin Hospital Department of Orthopaedic Surgery, Coral Gables, FL, USA
| | - Philip A. Sakalian
- Larkin Hospital Department of Orthopaedic Surgery, Coral Gables, FL, USA
| | - Arturo Corces
- Larkin Hospital Department of Orthopaedic Surgery, Coral Gables, FL, USA
| |
Collapse
|
5
|
Intermuscular Fat, But Not Subcutaneous Fat, Correlated With Major Complications After Primary Total Hip Arthroplasty. Acad Radiol 2022:S1076-6332(22)00505-0. [DOI: 10.1016/j.acra.2022.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 09/13/2022] [Accepted: 09/16/2022] [Indexed: 11/22/2022]
|
6
|
Frenkel Rutenberg T, Markman R, Rutenberg R, Daglan E, Rubin T, Shemesh S. Thickness of the Subcutaneous Fat as a Risk Factor for Surgical Site Infection Following Fragility Hip Fracture Surgery. Geriatr Orthop Surg Rehabil 2022; 13:21514593221080272. [PMID: 35223132 PMCID: PMC8874187 DOI: 10.1177/21514593221080272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 01/20/2022] [Accepted: 01/25/2022] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Surgical site infection (SSI) following fragility hip fracture (FHF) surgery is associated with increased morbidity and mortality. SIGNIFICANCE Prediction of patients at risk for SSI is fundamental. We aimed to determine whether subcutaneous radiographic fat measurement (SRM) is associated with increased SSI risk. METHODS A retrospective case-control comparison of SRMs at 3 locations around the hip. Patients diagnosed with SSI in the first post-operative year were matched with age, gender, surgical year, Charlsons' co-morbidity index score, and surgical type controls, not diagnosed with SSI, at a 1:2 ratio. Measurements included the distance between (1) the sourcil to skin surface (SS), (2) the tip of the greater trochanter to skin surface (TGTS), and (3) the most prominent lateral aspect of the greater trochanter to skin surface. RESULTS 1430 patients were operated during the study period, of whom 45 patients presented with a diagnosis of SSI and compared to 90 controls. Infections occurred 27.4 ( ± 24.8) days following surgery. SRM significantly differed between groups, and all were higher in the study group; SS, 86.8 ± 25.5 cm vs 74.2 ± 15.3 cm; TGTS, 59.8 ± 26.3 cm vs 47.0 ± 15.8 cm; and LGTS, 45.4 ± 25.1 cm vs 33.2 ± 15.1 cm (P = .003, .004, and .004, respectively). Intraclass correlation coefficients (intra-rater) were high for all measurements (.999 for all). Intraclass correlation coefficients (inter-rater) for SS, TGTS and LGTS were high, .749 (.663.815), .792 (.719.847) and .817 (.751.866), respectively. CONCLUSIONS SRMs were found to be a valid and reproducible tool for predicting high risk of SSI in geriatric patients sustaining FHFs. LEVEL OF EVIDENCE III.
Collapse
Affiliation(s)
- Tal Frenkel Rutenberg
- Orthopedic Department, Rabin Medical Center Beilinson Hospital, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Rotem Markman
- Orthopedic Department, Rabin Medical Center Beilinson Hospital, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ran Rutenberg
- Emergency Medicine Department, Rabin Medical Center Beilinson Hospital, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Efrat Daglan
- Orthopedic Department, Rabin Medical Center Beilinson Hospital, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tomer Rubin
- Orthopedic Department, Rabin Medical Center Beilinson Hospital, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shai Shemesh
- Orthopedic Department, Rabin Medical Center Beilinson Hospital, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
7
|
Rainer WG, Kolz JM, Wyles CC, Houdek MT, Perry KI, Lewallen DG. Lymphedema Is a Significant Risk Factor for Failure After Primary Total Hip Arthroplasty. J Bone Joint Surg Am 2022; 104:55-61. [PMID: 34637411 DOI: 10.2106/jbjs.20.01970] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Lymphedema is a chronic disease characterized by fluid buildup and swelling that can lead to skin and soft-tissue fibrosis and recurring soft-tissue infections. Literature with regard to the increased risk of complications following a surgical procedure in patients with lymphedema is emerging, but the impact of lymphedema in the setting of primary total hip arthroplasty (THA) remains unknown. The purpose of this study was to review outcomes following primary THA performed in patients with lymphedema compared with a matched cohort without lymphedema. METHODS Using our institutional total joint registry and medical records, we identified 83 patients (57 were female and 26 were male) who underwent THA with ipsilateral lymphedema. For comparison, these patients were matched 1:6 (based on sex, age, date of the surgical procedure, and body mass index [BMI]) to a group of 498 patients without lymphedema who underwent primary THA for osteoarthritis. Subsequently, postoperative complications and implant survivorship were evaluated for each group. The mean follow-up for each group was 6 years. Survivorship was compared between cohorts using Kaplan-Meier methodology and included both survivorship free of infection and survivorship free of reoperation or revision. Univariate Cox regression analysis was utilized to assess the association between patient factors for the time to event outcomes noted above. RESULTS In patients with a history of lymphedema, there was an increased risk of complications (hazard ratio [HR], 1.97; p < 0.01), including reoperation for any cause (HR, 3.16; p < 0.01) and postoperative infection (HR, 4.48; p < 0.01). The 5-year infection-free survival rate was 90.3% for patients with lymphedema compared with 97.7% for patients without lymphedema (p < 0.01). CONCLUSIONS Patients with lymphedema are at increased risk for complications, including reoperation and infection, following primary THA. These data emphasize the importance of appropriate preoperative counseling in this population and should encourage efforts to identify methods to improve outcomes, including further investigation of the effects of preoperative optimization of lymphedema prior to THA and methods for improved perioperative management. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- William G Rainer
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | | | | | | | | | | |
Collapse
|
8
|
Sezgin EA, Ali AK, Ataoğlu MB, Orhan Ö, Odluyurt M, Esen E. Novel radiographic hip fat thickness ratio correlates with early re-operation following total hip arthroplasty. Hip Int 2022; 32:62-66. [PMID: 33682484 DOI: 10.1177/1120700021991783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Obesity is thought to lead to increased failure rates following total hip arthroplasty (THA). Site-specific fat distribution has been suggested to be a better indicator of risk, compared to body mass index. Fat thickness measurement methods were developed for total knee arthroplasty, however, there is limited data on the methods for THA. The aim of this study was to assess the interobserver and intraobserver reliability of a newly defined radiographic subcutaneous fat thickness ratio and investigate the correlation of this ratio with early failure following THA. METHODS 321 patients who underwent primary THA at a single institution between 2014 and 2017, with at least 1-year of follow-up and a preoperative pelvis anteroposterior x-ray radiograph were included in this study. A high hip fat thickness ratio (HFTR) was arbitrarily defined as ⩾2. Early failure was defined as revision or re-operation for any reason and death related to operation first year following THA. RESULTS The HFTR was shown to have excellent intraobserver and interobserver reliability. High HFTR was associated with higher risk of early failure following THA (odds ratio 3.8, [95% confidence interval, 1.2-12.1], p < 0.05). The same association persisted when HFTR was analysed as a continuous variable (p < 0.01) and in multivariate analysis (p < 0.05). CONCLUSIONS HFTR can be used to assess periarticular soft tissue distribution and may be regarded as a useful and reproducible tool for assessing risk of early failure following THA.
Collapse
Affiliation(s)
- Erdem A Sezgin
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Gazi University, Ankara, Turkey.,Department of Orthopaedics and Traumatology, Aksaray University Training and Research Hospital, Aksaray, Turkey
| | - Ali K Ali
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Kirkuk University, Kirkuk, Iraq
| | - M Baybars Ataoğlu
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Özlem Orhan
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Gazi University, Ankara, Turkey.,Şanlıurfa Training and Research Hospital, Department of Orthopaedics and Traumatology, Şanlıurfa, Turkey
| | - Mustafa Odluyurt
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Erdinç Esen
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Gazi University, Ankara, Turkey
| |
Collapse
|
9
|
Rey Fernández L, Angles Crespo F, Miguela Álvarez SM, Bernaus-Johnson MC, Bartra Ylla A, Font-Vizcarra L. Soft-tissue thickness radiographic measurement: a marker to evaluate acute periprosthetic joint infection risk in total hip replacement. J Bone Jt Infect 2021; 6:211-217. [PMID: 34159045 PMCID: PMC8209611 DOI: 10.5194/jbji-6-211-2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 05/02/2021] [Indexed: 12/04/2022] Open
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.
Collapse
Affiliation(s)
- Laura Rey Fernández
- Department of Traumatology and Orthopaedic Surgery, Hospital Universitari Mútua Terrassa, Barcelona, Spain
| | - Francesc Angles Crespo
- Department of Traumatology and Orthopaedic Surgery, Hospital Universitari Mútua Terrassa, Barcelona, Spain.,Department of Surgery, Universitat de Barcelona, Barcelona, Spain
| | | | | | - Agustí Bartra Ylla
- Department of Traumatology and Orthopaedic Surgery, Hospital Universitari Mútua Terrassa, Barcelona, Spain
| | - Lluís Font-Vizcarra
- Department of Traumatology and Orthopaedic Surgery, Hospital Universitari Mútua Terrassa, Barcelona, Spain
| |
Collapse
|
10
|
Mayne AIW, Cassidy RS, Magill P, Diamond OJ, Beverland DE. Increased fat depth is not associated with increased risk of surgical complications following total hip arthroplasty. Bone Joint J 2020; 102-B:1146-1150. [PMID: 32862677 DOI: 10.1302/0301-620x.102b9.bjj-2020-0207.r1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
AIMS Previous research has demonstrated increased early complication rates following total hip arthroplasty (THA) in obese patients, as defined by body mass index (BMI). Subcutaneous fat depth (FD) has been shown to be an independent risk factor for wound infection in cervical and lumbar spine surgery, as well as after abdominal laparotomy. The aim of this study was to investigate whether increased peritrochanteric FD was associated with an increased risk of complications in the first year following THA. METHODS We analyzed prospectively collected data on a consecutive series of 1,220 primary THAs from June 2013 until May 2018. The vertical soft tissue depth from the most prominent part of the greater trochanter to the skin was measured intraoperatively using a sterile ruler and recorded to the nearest millimetre. BMI was calculated at the patient's preoperative assessment. All surgical complications occuring within the initial 12 months of follow-up were identified. RESULTS Females had a significantly greater FD at the greater trochanter in comparison to males (median 3.0 cm (interquartile range (IQR) 2.3 to 4.0) vs 2.0 cm (IQR 1.7 to 3.0); p < 0.001) despite equivalent BMI between sexes (male median BMI 30.0 kg/m2 (IQR 27.0 to 33.0); female median 29.0 kg/m2 (IQR 25.0 to 33.0)). FD showed a weak correlation with BMI (R² 0.41 males and R² 0.43 females). Patients with the greatest FD (upper quartile) were at no greater risk of complications compared with patients with the lowest FD (lower quartile); 7/311 (2.3%) vs 9/439 (2.1%); p = 0.820 . Conversely, patients with the highest BMI (≥ 40 kg/m2) had a significantly increased risk of complications compared with patients with lower BMI (< 40 kg/m2); 5/60 (8.3% vs 18/1,160 (1.6%), odds ratio (OR) 5.77 (95% confidence interval (CI) 2.1 to 16.1; p = 0.001)). CONCLUSION We found no relationship between peritrochanteric FD and the risk of surgical complications following primary THA. Cite this article: Bone Joint J 2020;102-B(9):1146-1150.
Collapse
Affiliation(s)
| | | | - Paul Magill
- Primary Joint Unit, Musgrave Park Hospital, Belfast, UK
| | | | | |
Collapse
|