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Perioperative medical management during total hip arthroplasty (THA) is continuously improving, allowing an increasing number of medically complex patients to undergo total joint arthroplasty. This study examined mortalities, medical complications, implant survivorships, and clinical outcomes of THA in patients who have pulmonary hypertension (HTN).We identified 638 patients who had pulmonary HTN and underwent 508 primary THAs and 191 revision THAs from 2000 to 2016 at a tertiary care center. Patients were followed up at regular intervals until death, revision surgery, or last clinical follow-up. Perioperative medical complications were individually reviewed. The risk of death was examined by calculating standardized mortality ratios and Cox proportional hazards regression models. Cumulative incidence analyses were used for reporting mortality, reoperation, and revision with death as a competing risk.The 90-day mortality was 1.8 and 3.1% for primary and revision THAs, respectively. The risk of death was approximately two-fold higher compared to primary (HR 2.69) and revision (HR 2.04) THA patients who did not have pulmonary HTN. Rate of medical complications within 90 days from surgery were 6.2 and 13.1% in primary and revision THAs, respectively. The 10-year cumulative incidence of any revision was 9 and 14% following primaries and revisions, respectively.Patients who had pulmonary HTN undergoing primary and revision THAs had increased risk of death and experienced a high rate of medical complications within 90 days of surgery. Counseling of risks, medical optimization, and referral to medical centers expert at managing complex medical problems should be considered.

The objective of this study was to evaluate the reoperation and complication rate following trochanteric plate fixation of greater trochanter (GT) periprosthetic femur fractures associated with total hip arthroplasty and to identify risk factors for subsequent reoperation, nonunion, and hardware failure (plate/cable breakage or migration).Between 2010 and 2020, 44 patients who had 44 periprosthetic greater trochanter fractures at mean follow up of 2 years were retrospectively reviewed. Initial injury radiographs as well as immediate and final follow-up radiographs were evaluated. Subsequent reoperations, nonunion, and cases of hardware failure were identified. There were 22 (50%) Vancouver B2 fractures and 22 (50%) Vancouver A fractures.The 2-year cumulative probability of any subsequent reoperation was 20%. There were 9 total subsequent reoperations. The trochanteric fracture went on to nonunion in 14 patients (39%), and hardware failure occurred in 10 (28%) patients. A trochanteric bolt was used in addition to the trochanteric plate in 6 patients (14%), of which 4 (67%) patients had trochanteric plate displacement and 3 (50%) patients had trochanteric nonunion. Displacement of the greater trochanter prior to fixation was a predictor of subsequent nonunion (77% versus 23%, P = .02).In this large contemporary series, there was a high incidence of reoperation (20%) with in the first 2-years following plating of periprosthetic GT fractures, as well as a high rate of nonunion (39%), and hardware failure (28%). Displacement of the GT prior to plating predicted nonunion.Level IV, retrospective observational study.

There is a relative paucity of literature on the outcomes after revision total hip arthroplasty (rTHA) in young patients. This study reports the survivorship and risk factors for re-revision in patients aged ≤55 years.We identified 354 patients undergoing aseptic nononcologic rTHA at mean follow-up of 5 years after revision, with mean age of 48 years, body mass index of 28 kg/mSixty-two patients (18%) underwent re-revision THA at the mean time of 2.5 years, most commonly for instability (37%), aseptic loosening (27%), and prosthetic joint infection (15%). The rTHA survivorship from all-cause re-revision and reoperation was 83% and 79% at 5 years, respectively. Multivariate analysis demonstrated that patients undergoing femoral component only (hazard ratio 4.8, P = .014) and head/liner exchange rTHA (hazard ratio 2.5, P = .022) as risk factors for re-revision THA.About 1 in 5 patients aged ≤55 years undergoing rTHA required re-revision THA at 5 years, most commonly for instability. The highest risk group included patients undergoing head/liner exchanges and isolated femoral component revisions.

Preoperative opioid use increases opioid consumption postoperatively, but the effect of tramadol is poorly understood.We retrospectively reviewed 11,667 patients undergoing primary unilateral THA and TKA at a single institution. Preoperatively, there were 8,201 opioid-naïve patients (70.3%), 1,315 on tramadol (11.3%), 1,408 on narcotics (12.1%) and 743 on narcotics and tramadol (6.3%). We compared morphine milligram equivalents (MMEs) used during hospitalization, prescribed at discharge, and refilled during the first 90 days. We used multivariate analysis to assess whether preoperative tramadol use was associated with increased number of refills and total refilled MMEs.Total in-hospital MMEs and daily MMEs was lowest for the opioid naïve patients and significantly increased for the remaining three groups (total in-hospital use: 119, 152, 211, and 196 MMEs, respectively-P.001) (daily in-hospital use: 66, 74, 100, and 86 MMEs, respectively-P.001). Opioid refill rate was significantly higher for all patients who were not opioid naïve (32%, 42%, 41%, and 52%, respectively-P.001). Total MMEs prescribed after discharge was lowest for opioid naïve patients (477, 528, 590 and 658, respectively-P.001). Logistic and linear regression controlling for age, sex, history of anxiety/depression revealed that THA patients taking tramadol preoperatively were 2.5 times more likely to require post-discharge refills and refilled 80 additional MMEs than opioid naïve patients (P.001).Tramadol is not recommended for pain beforeTKA or THA, and surgeons and patients should be aware that it is associated with a substantial increase in postoperative opioid use.

There is a paucity of data on blood loss and the risk of allogeneic blood transfusion after simultaneous bilateral total hip arthroplasty (SBTHA) with contemporary blood management including neuraxial anesthesia, routine tranexamic acid use, and a restrictive transfusion protocol. As such, we sought to determine the in-hospital outcomes of SBTHA, specifically analyzing blood loss and the rate and risk factors for transfusion.We identified 191 patients who underwent SBTHA at a single institution from 2016 to 2019. No drains were utilized and no patients donated blood preoperatively. Mean age was 59 years with 96 females (50.3%). The surgical approach was posterior in 138 (72.3%) and direct anterior in 53 (27.7%) patients. We analyzed blood loss, the rate of allogeneic blood transfusions, and in-hospital thromboembolic complications. We analyzed risk factors for transfusion with a logistic regression analysis.Twenty-two patients (11.5%) underwent allogeneic blood transfusion. All transfused patients were female. Univariate analysis revealed female gender as a transfusion risk factor since it had statistically significant higher proportion in the transfusion group than the nontransfusion group (100% vs 43.5%, respectively, P.001). We did not identify any other singular significant risk factors for transfusion in a multivariable regression analysis. However, females with a preoperative Hb12 had an elevated risk of transfusion at 37.5% (15/40 patients).With contemporary perioperative blood management protocols, there is a relatively low (11.5%) risk of a blood transfusion after SBTHA. Females with a lower preoperative Hb (12 g/dL) had the highest risk of transfusion at 37.5%.

Background There is a paucity of data on the outcomes of distal femoral replacements (DFRs) in patients with total knee arthroplasty (TKA) periprosthetic fractures. We sought to characterize these patients’ survivorship free from rerevision. Methods We retrospectively identified 49 patients, including 34 after primary TKA (primary cohort), 9 after revision TKA, and 6 conversions for failed open reduction and internal fixation (revision cohort) that underwent DFR for a periprosthetic femur fracture. The mean age was 76 years, and 40 patients (82%) were female. The mean follow-up was 4 years. Femoral fixation included 44 cemented stems (90%) and 5 cementless stems (10%). Survivorship free from rerevision was characterized by the Kaplan–Meier method; cox proportional regression was used to analyze the risk factors for rerevision. Results Survivorship free from any rerevision at 5 years in the primary and revision cohort was 93% and 18%, respectively. The revision cohort had a 5.3× higher risk of re-revision (P = .008). Survivorship free from re-revision for aseptic loosening at 5 years in the primary and revision cohort was 93% and 53%, respectively. Two of the 3 patients with cementless stems in the primary cohort underwent early rerevision for aseptic loosening, but patients with prior primary TKAs treated with cemented femoral fixation (n = 31) had a 97% 5-year survivorship free from re-revision. Conclusion Patients with periprosthetic fractures around prior primary TKAs treated with DFRs with cemented femoral fixation had a 97% 5-year survivorship free from any re-revision. DFRs for periprosthetic femur fractures around revision TKAs or conversions of failed open reduction and internal fixations have a 5× increased risk of rerevision.

Historically, there was up to a 60% risk of blood transfusion for patients undergoing simultaneous bilateral total knee arthroplasty (SBTKA). As such, the goal of this study was to analyze the rate and risk factors for allogeneic blood transfusions in patients undergoing SBTKA with tranexamic acid (TXA).We retrospectively identified 475 patients who underwent SBTKA with a double dose TXA regimen at a single institution from 2016 to 2019. Mean age was 65 years. Two hundred fifty-seven patients (54%) were female. Mean body mass index was 30 kg/mOne hundred six patients (22%) received an allogeneic transfusion, including 28 patients (6%) who received ≥2 units. Multivariate analysis showed that preoperative Hgb12.5 (OR = 3.99, P.0001), female sex (OR = 2.34, P = .002), and drain use (OR = 2.13, P = .004) were risk factors for transfusion. Forty-two patients (42/83, 51%) with a preoperative Hgb12.5 received a transfusion compared with 64 patients (64/392, 16%) with a Hgb ≥12.5 (P.001).Patients undergoing SBTKA with contemporary blood management still have a 1 in 5 rate of allogeneic transfusion. Drain use independently increases transfusion risk by 2-fold and should be avoided. Patients with a preoperative Hgb12.5 have a transfusion rate of 50% and, as such, should either not undergo SBTKA or have extensive perioperative blood optimization.

Background: The optimal route and dosing regimen of tranexamic acid (TXA) in primary total hip arthroplasty (THA) and total knee arthroplasty (TKA) remain unclear. As such, we sought to analyze if there was a synergistic effect of intravenous (IV) and topical TXA on blood loss and transfusions. Methods: We retrospectively analyzed 6720 primary TKAs and 6559 THAs performed from February 1, 2016 to December 31, 2019 at a single institution in patients who received a double IV dose (6159 TKAs and 6276 THAs) compared with a combined single IV and topical dose (561 TKAs and 283 THAs) of TXA. Multivariate logistic regression models, adjusting for age, body mass index, American Society of Anesthesiologists class, preoperative hemoglobin, and TXA administration, were performed for significant variables from a univariate analysis. Results: In the TKA cohort, the mean total blood loss was statistically similar for double IV (305 mL, 95% confidence interval [CI] = 301-310 mL) TXA compared with combined TXA (310 mL, 95% CI = 299-321 mL) (P = .43). Furthermore, there was no difference in the rate of transfusion (odds ratio = 1.23, 95% CI = 0.57-2.67, P = .598). In the THA cohort, there was statistically higher blood loss with double IV (328 mL, 95% CI = 323-333 mL) TXA than in the combined group (295 mL, 95% CI = 280-310 mL) (P < .001). The rate of transfusion was statistically similar at ~2% (P = .970). Conclusions: A double IV TXA dose and a combined single IV and topical TXA dose were equally effective in minimizing blood transfusions (~2%) at primary TKA and THA. We did not find a synergistic effect when combining a systemic IV TXA with a topical TXA. Level of Evidence: Level III.

Background: Prior spinal fusion significantly increases the risk of dislocation in patients after total hip arthroplasty (THA). Owing to these high risks, surgeons may use dual-mobility (DM) constructs in these patients to optimize hip stability. However, there is a paucity of data on the outcomes of DM constructs in patients who underwent prior spinal fusions. Methods: We retrospectively identified 80 patients (86 THAs) who underwent a spinal arthrodesis and a subsequent posterior approach THA with a DM construct. The median number of levels fused was 4, with 59 (74%) patients having 2 or more levels fused; in addition, 50 (63%) patients were fused to the sacrum. Ninety percent and 55% of THAs were within the Lewinnek safe zone for inclination and anteversion, respectively. Patients were evaluated for any episode of hip instability, complications, and patient reported outcome measures. Results: At 3-year mean follow-up, no patients sustained a postoperative dislocation or intraprosthetic dislocation (0%). Overall, there were 6 (7.5%) complications during the study period leading to reoperation in 3 (4%) patients, none related to the acetabular component or instability. Hip Injury and Osteoarthritis Outcome Score, Joint Replacement scores significantly improved from a mean of 50 preoperatively to 87 postoperatively (P < .001), and the Veterans Rand 12 Item Health Survey physical score improved from a mean of 31 preoperatively to 44 postoperatively (P < .001). Conclusion: In a high-risk series of patients who underwent prior spinal fusion, posterolateral primary THA with a DM construct demonstrated no dislocations at mean 3-year follow-up. Although these early data are clearly encouraging, more patients with longer term follow-up are needed.

Background There are little data on the outcomes of primary total hip arthroplasties (THAs) in patients with a prior surgically treated hip or knee periprosthetic joint injection (PJI). The goal of this study was to compare the risk of infection in this population with matched controls. Methods We retrospectively reviewed 48 patients whom underwent 50 primary THAs from 2000 to 2014 with a history of a PJI in a total knee arthroplasty or contralateral THA. Thirteen patients (27%) were on chronic antibiotic suppression at the time of primary THA. Mean age was 67 years, and mean body mass index was 35 kg/m2. Mean follow-up was 6 years. We 1:3 matched (age, sex, body mass index, cemented vs cementless femoral fixation, and surgical year) these cases to 150 primary THAs. Competing risk analysis, with death as the competing risk, was performed. Results The cumulative incidence of PJI with death as a competing risk was 1.5-fold higher in the study cohort (2.0%) compared with matched controls (1.4%) (hazards ratio, 1.5; P = .75). The cumulative incidence of any infection with death as a competing risk was 2-fold higher in the study cohort (4.0%) compared with matched controls (2.1%) (hazards ratio, 2.0; P = .45). However, these were both statistically similar given the relatively small cohort. The overall complication rate, including infections and reoperations, was 17% in the study cohort. Conclusion Patients undergoing a clean primary THA with a history of a total knee arthroplasty or contralateral THA PJI in another joint have a 2% and 4% risk of PJI and any infection, respectively. Moreover, nearly 1 in 5 patients experience at least 1 complication.

BACKGROUND Hemochromatosis can result in metabolic bone pathology (due to excessive iron absorption) and degenerative joint disease, leading to total joint arthroplasties. The aim of this study is to analyze the survivorship, complications, radiographic results, and clinical outcomes of patients with hemochromatosis who received either a total hip arthroplasty (THA) or a total knee arthroplasty (TKA). METHODS We identified 34 lower extremity arthroplasties in 29 patients with hemochromatosis performed between 2000 and 2016. There were 17 primary THAs in 15 patients and 17 primary TKAs in 14 patients. Mean age at arthroplasty was 63 years with 76% being male. The mean body mass index was 28 kg/m2. Mean follow-up was 5 years. RESULTS The survivorship free from any revision for THAs was 94% at 10 years. One patient was revised for aseptic loosening of the femoral stem at 6 months. In THA patients, no infections, no other complications, and no radiographic evidence of aseptic loosening were identified. Harris Hip Scores improved from a mean of 55 preoperatively to 94 postoperatively (P < .001). The survivorship free from any revision for TKAs was 100% at 10 years. Two patients (12%) developed acquired idiopathic stiffness postoperatively; no infections were identified. There was no radiographic evidence of aseptic loosening in any TKA. Knee Society Scores improved from a mean of 61 preoperatively to 94 postoperatively (P < .001). CONCLUSION This study found excellent survivorship, significant improvements in clinical outcomes, and a very low complication profile for both THA and TKA in patients with hemochromatosis.

Background There is a paucity of literature on contemporary aseptic revision total knee arthroplasty in patients ≤50 years. We sought to determine risk factors for failure in this population, with specific emphasis on survivorship free of (1) all-cause re-revision and (2) re-revision for instability. Methods We retrospectively reviewed 135 nononcologic revision total knee arthroplasties (TKAs) performed from 2000 to 2012 in patients ≤50 years. Mean age was 43 years, and mean body mass index was 31 kg/m2. Mean follow-up was 7 years. There were 99 (73%) first-time revisions, and 36 (27%) with prior revisions. Indications for revision included instability (47%), aseptic loosening (29%), and arthrofibrosis (9%). Multivariate Cox regression analysis was used to identify risk factors. Results Survivorship free of all-cause re-revision was 66% at 10 years, with multiply revised TKAs (hazard ratio [HR] = 2.6, P = .008) having the poorest survivorship. Forty-three (32%) TKAs underwent re-revision including 10 (7%) for periprosthetic joint infection. Survivorship free of re-revision for instability was 88% at 10 years, with revision for instability (HR = 19, P = .03), male gender (HR = 3.0, P = .05), and multiply revised TKAs (HR = 3.5, P = .03) having poorer survival. Of the 64 TKAs revised for instability, 24 (38%) underwent re-revision, including 14 (22%) for recurrent instability. Conclusion Patients ≤50 years undergoing contemporary aseptic revision TKA had a 1 in 3 risk of re-revision. Patients specifically revised for instability or had prior TKA revisions had the highest risk of re-revision at 10 years. Level of Evidence IV.

Background Neuropathic (Charcot) arthropathy of the hip is rare but can lead to joint destruction, bone loss, and dysfunction. While total hip arthroplasty (THA) may be considered a treatment option, only very limited data in the form of case reports are available on the results of THA. The goal of this study was to analyze the outcomes of primary THA for Charcot arthropathy with emphasis on implant survivorship, complications, and clinical outcomes. Methods Eleven patients undergoing 12 primary THAs for Charcot arthropathy from 2007 to 2014 were retrospectively reviewed. All patients had a severe underlying neuropathy and clear radiographic evidence of Charcot arthropathy. Mean age was 54 years with 4 patients being female. Mean follow-up was 5 years. Results Survivorship free of any revision was 75% at both 2 and 5 years. Three THAs (3/12) were revised: 2 for recurrent instability and 1 for femoral component loosening. Survivorship free of any reoperation was 67% at both 2 and 5 years. One additional THA underwent open reduction and internal fixation of a Vancouver B1 periprosthetic fracture. The overall complication rate (including revisions and reoperations) was high at 58% with 3 recurrent dislocations, 2 periprosthetic fractures, 1 femoral component loosening, and 1 delayed wound healing. Harris Hip Scores improved from a mean of 43 preoperatively to 81 postoperatively (P Conclusion In this study, the largest to date, we found that patients undergoing primary THA for Charcot arthropathy have a significant improvement in clinical outcomes but that there was a high risk of early complications and revisions, mostly related to recurrent instability. Specific precautions to avoid early complications, namely utilization of components that provide robust fixation and strategies that provide enhanced hip stability, should be considered. Level of Evidence Level IV.

Perioperative blood loss during elective total joint arthroplasty (TJA) can be significant, traditionally resulting in high blood transfusion rates. However, due to the risks and costs of allogeneic blood transfusion, the focus in contemporary TJA has been on strategies to minimize perioperative blood loss. While a multimodal approach is paramount in elective TJA, three main factors have contributed dramatically to the reduced allogeneic blood transfusion rates: (1) preoperative assessment and treatment of anemia, (2) expanded use of antifibrinolytics, particularly tranexamic acid (TXA), and (3) a restrictive transfusion strategy postoperatively.

Background There are limited data on evaluating the significance of radiolucent lines and aseptic loosening in total knee arthroplasty (TKA). We sought to compare the sensitivity, specificity, and reliability of the Knee Society Total Knee Arthroplasty Roentgenographic Evaluation and Scoring System (KSRES) in detecting tibial component loosening compared to a novel percentage-based system (PBS). Methods We retrospectively reviewed radiographs obtained from 48 patients within 6 months prior to revision TKA. The radiographs were randomized and four reviewers independently used the KSRES to categorize tibial implants as nonconcerning, clinical follow-up for progression, or loose as described by KSRES. For the PBS, the percent involvement of the tibial implant interface of any radiolucency at the bone-cement or cement-implant interface was determined. The higher percentage from either the anteroposterior or the lateral image was the final score. Components were categorized as nonconcerning (≤10%), clinical follow-up for progression (11%-24%), or loose (≥25%). We compared the sensitivity, specificity, and interobserver reliability using intraoperative assessment of implant fixation as the gold standard. Results For the KSRES, the mean sensitivity for determining tibial loosening was 7.3% and mean specificity for determining a nonconcerning implant was 95.9%. The PBS significantly increased the sensitivity to 91.1% ( P P = .2). Interobserver reliability significantly increased from a mean kappa of 0.26 to 0.75 ( P Conclusion The KSRES significantly underestimates implant loosening. The proposed percentage-based system demonstrated excellent sensitivity, specificity, and interobserver reliability in determining tibial implant loosening in this patient population.

Background Metaphyseal fixation has promising early results in providing component stability and fixation in revision total knee arthroplasty (TKA). However, there are limited studies on midterm results of metaphyseal sleeves. We analyzed complications, rerevisions, and survivorship free of revision for aseptic loosening of metaphyseal sleeves in revision TKA. Methods Two hundred eighty patients with 393 metaphyseal sleeves (144 femoral, 249 tibial) implanted during revision TKA from 2006-2014 were reviewed. Sleeves were most commonly cemented (55% femoral, 72% tibial). Mean follow-up was 3 years, mean age was 66 years, and mean body mass index was 34 kg/m 2 . Indications for revision TKA included 2-stage reimplantation for deep infection (37%), aseptic loosening of the tibia (14%), femur (12%), or both components (9%), and instability (14%). Results There was a 12% rate of perioperative complications, most commonly intraoperative fracture (6.5%). Eight sleeves (2.5%) required removal: 6 (2%) during component resection for deep infection (all were well-fixed at removal) as well as 1 (0.8%) femoral sleeve and 1 (0.8%) tibial sleeve for aseptic loosening. Five-year survivorship free of revision for aseptic loosening was 96% and 99.5% for femoral and tibial sleeves, respectively. Level of constraint, bone loss, sleeve and/or stem fixation, and revision indication did not significantly affect outcomes. Conclusion Metaphyseal sleeve fixation to enhance component stability during revision TKA has a 5-year survivorship free of revision for aseptic loosening of 96% and 99.5% in femoral and tibial sleeves, respectively. Both cemented and cementless sleeve fixation provides reliable durability at intermediate follow-up.

Background Fluoroscopically assisted radiographs theoretically improve detection of total knee arthroplasty (TKA) implant loosening by providing a better evaluation of the true implant interface, but their utility has not been well studied. We sought to determine whether fluoroscopically guided radiographs improve the sensitivity, specificity, and interobserver reliability of determining TKA implant loosening compared to standard radiographs. Methods Standard anteroposterior and lateral and fluoroscopically assisted radiographs were retrospectively obtained from 60 patients within 6 months before revision TKA. Thirty knees were revised for aseptic loosening and 30 knees for other indications, most commonly instability. The radiographs were randomized. Four reviewers independently determined whether each tibial and femoral component was radiographically loose or stable. Intraoperative determination of implant stability was utilized as the gold standard. Results Fluoroscopically guided radiographs had a significantly higher sensitivity for detecting tibial component loosening compared to standard radiographs (85.3% vs 74.8%, P = .02). Sensitivity in detecting femoral component loosening was poor overall and not improved by fluoroscopic enhancement compared to standard radiographs (58.8% vs 66.5%, P = .33). Fluoroscopically guided radiographs did not improve the specificity of detecting well-fixed implants in either tibial or femoral components nor affect the mean interobserver reliability over standard radiographs (kappa = 0.58 vs kappa = 0.60, P = .6). Conclusion Fluoroscopically assisted radiographs increased the sensitivity of detecting tibial component loosening over standard radiographs, but this clinical significance is unclear. Fluoroscopically guided radiographs may provide benefit in diagnosing aseptic loosening in select patients with painful TKAs.

Background Clinical outcomes remain largely unknown beyond perioperative and short-term follow-up of solid organ transplant (SOT) patients undergoing total knee arthroplasty (TKA). Methods Patient mortality, implant survivorship, and complications of 96 TKAs (76 patients) after SOT were retrospectively reviewed through an internal joint registry. Mean age at index arthroplasty was 66 years, and mean follow-up was 4 years. Results Overall mortality rates at 1 year, 2 years, and 5 years from TKA were 2.6%, 7.9%, and 13.2%, respectively, and combined SOT patient survivorship was 92% at 2 years and 82% at 5 years. Implant survivorship free of any component revision or implant removal was 98% at 2 years and 93% at 5 years. There was a high rate of perioperative complications (12.5%), including periprosthetic fractures (5.2%) and deep periprosthetic infection (3.2%). Conclusion TKA does not appear to have any effect on SOT patient survivorship following the procedure. However, SOT patients may have a higher risk of perioperative complications and a lower implant survivorship than the general population of TKA patients at midterm follow-up.

Background Although a growing number of primary total hip arthroplasties (THAs) are being performed on solid-organ transplant (SOT) recipients, long-term patient and implant survivorships have not been well studied in contemporary transplant and arthroplasty practices. Methods A total of 136 THAs (105 patients) with prior SOT were retrospectively reviewed from 2000 to 2013 at mean clinical follow-up of 5 years. The mean age was 59 years, with 39% being females. The most common SOT was renal (56%), followed by liver (24%). Results Patient mortality was 3.8% and 13.3% at 2 and 5 years, respectively. There were 9 revisions (6.6%), including 5 (4%) for deep periprosthetic infection. Implant survivorship free of any revision was 95% and 94% at 2 and 5 years, respectively. Transplant type or surgical indication did not significantly impact patient or implant survivorship. Conclusion Compared with the general population, SOT patients undergoing THA have slightly higher mortality rates at 5 years. Implant survivorship free of revision was slightly lower than the general population, primarily due to an increased risk of periprosthetic joint infection.

Background Addressing recurrent instability in patients with poor bone stock and inadequate abductor tensioning remains a challenge in revision total hip arthroplasty. One treatment method is implantation of a constrained liner. The purpose of this study was to determine clinical outcomes, redislocation rate, and revisions of a focally constrained liner in a high-risk patient cohort. Methods Fifty-eight hips between 2008 and 2011 underwent implantation of a focally constrained liner. Nineteen were placed concurrent with acetabular component revision and 39 were placed into a well-fixed acetabular shell. Mean age was 69 years and mean number of previous ipsilateral hip surgeries was 4.2. At mean follow-up of 3.5 years, we analyzed clinical outcomes, redislocation, and revisions. Results Mean Harris Hip Scores was 74. Fourteen hips (24%) were revised and 3 hips (5%) required reoperation at final follow-up. Eleven hips (19%) redislocated at a mean time to dislocation of 12.2 months; 31% (11 of 36 patients) that underwent modular exchange specifically for instability redislocated. Risk factors for redislocation included number of previous surgeries (P = .013), implantation of a 28 mm femoral head (hazards ratio 12.8), revision indication of instability (P = .04), and modular exchange with constrained liner implantation without acetabular shell revision (P = .01). Conclusion Implantation of a focally constrained liner in revision total hip arthroplasty for recurrent instability has a high failure rate, especially with a modular exchange. Although concurrent acetabular revision had a lower redislocation rate, the decision to revise a well-fixed cup should be weighed with potential complications associated with cup revision.

We sought to identify patient and surgical risk factors for wound complication following direct anterior total hip arthroplasty (THA) and to compare these findings with a group of posterior approach patients. We retrospectively reviewed 716 direct anterior THAs performed by a single surgeon and 3040 posterior THAs from our institution performed from 2010 to 2014. Wound complications were noted in 1.7% of DA cases and 1.9% of posterior cases (P=0.76). Obesity was a stronger risk factor for wound complication in DA patients (HR 4.3, P=0.018) than in posterior approach patients (HR 1.4, P=0.22). The increased risk of wound complication should be taken into consideration prior to direct anterior THA in obese patients.