Search

Postoperative spinopelvic changes are associated with increased dislocation risk following total hip arthroplasty (THA). The aim of this study was to identify preoperative patient and radiographic factors associated with high-risk postoperative spinopelvic parameters. A retrospective review of consecutive THA patients who received preoperative and postoperative sitting and standing lateral lumbar spine-hip radiographs with minimum radiographic and clinical follow-up of 10 months was performed. Patient demographics were recorded and preoperative standing and sitting sacral slope (SS), anteinclination, pelvic femoral angle (PFA), and combined sagittal index (CSI) were measured. High-risk patients were defined by decreased spinopelvic motion (∆SS from sitting to standing of >10°), increased hip motion (∆PFA from sitting to standing of >10°), or decreased CSI of >10° at final follow-up compared with preoperative measurements. Univariate and multivariate regression analyses were used to identify preoperative demographic and radiographic factors associated with these high-risk categories. One hundred and fifty-three patients were included with an average age of 62 years, average body mass index of 27.8 kg/m 2 , and average follow-up of 16.2 months. At 1-year follow-up, 43 (28.1%) patients demonstrated a decreased ∆SS > 10° and 67 (43.7%) patients demonstrated an increased ∆PFA > 10° compared with preoperative values. Sitting CSI decreased by >10° in 17 (11.1%) patients. Preoperative increased sitting PFA (adjusted odds ratio [aOR] 1.057, p < 0.001) and decreased preoperative hip motion (∆PFA) were associated with decreased sitting CSI of >10° at 10-month follow-up. Increased spinopelvic motion (∆SS) and decreased hip motion (∆PFA) preoperatively are associated with postoperative radiographic changes that be associated with increased dislocation risk., (© 2023 Orthopaedic Research Society. Published by Wiley Periodicals LLC.)

Background: An optimal venous thromboembolism prophylaxis agent should balance efficacy and safety. While rivaroxaban provides effective venous thromboembolism prophylaxis after total joint arthroplasty, it may be associated with higher rates of bleeding. This study aimed to compare the safety and efficacy of rivaroxaban to aspirin and enoxaparin., Methods: A large national database was queried for patients who underwent elective primary total hip (THA) or total knee arthroplasty (TKA) from January 2015 through December 2020 who received rivaroxaban, aspirin, or enoxaparin. Multivariate analyses were performed to assess the 90-day risk of bleeding and thromboembolic complications. Among TKA patients identified, 86,721 (10.8%) received rivaroxaban, 408,038 (50.8%) received aspirin, and 108,377 (13.5%) received enoxaparin. Among THA patients, 42,469 (9.5%) received rivaroxaban, 242,876 (54.5%) received aspirin, and 59,727 (13.4%) received enoxaparin., Results: After accounting for confounding factors, rivaroxaban was associated with increased risk of transfusion (TKA: adjusted odds ratio [aOR] = 2.58, P < .001; THA: aOR 1.64, P < .001), pulmonary embolism (TKA: aOR = 1.25, P = .007), and deep vein thrombosis (TKA: aOR = 1.13, P = .022) compared to aspirin. Compared to enoxaparin, rivaroxaban was associated with an increased risk of combined bleeding events (TKA: aOR = 1.07, P < .001, THA: aOR = 1.11, P < .001), but decreased risk of combined prothrombotic events (THA: aOR = 0.85, P = .036)., Conclusion: Rivaroxaban chemoprophylaxis following TKA and THA was associated with an increased risk of bleeding and prothrombotic complications compared to aspirin and enoxaparin., (Copyright © 2023 Elsevier Inc. All rights reserved.)

It has been well documented in the arthroplasty literature that lumbar degenerative disc disease (DDD) contributes to abnormal spinopelvic motion. However, the relationship between the severity or pattern of hip osteoarthritis (OA) as measured on an anteroposterior (AP) pelvic view and spinopelvic biomechanics has not been well investigated. Therefore, the aim of the study is to examine the association between the severity and pattern of hip OA and spinopelvic motion. A retrospective chart review was conducted to identify patients undergoing primary total hip arthroplasty (THA). Plain AP pelvic radiographs were reviewed to document the morphological characteristic of osteoarthritic hips. Lateral spine-pelvis-hip sitting and standing plain radiographs were used to measure sacral slope (SS) and pelvic femoral angle (PFA) in each position. Lumbar disc spaces were measured to determine the presence of DDD. The difference between sitting and standing SS and PFA were calculated to quantify spinopelvic motion (ΔSS) and hip motion (ΔPFA), respectively. Univariate analysis and Pearson correlation were used to identify morphological hip characteristics associated with changes in spinopelvic motion. In total, 139 patients were included. Increased spinopelvic motion was observed in patients with loss of femoral head contour, cam deformity, and acetabular bone loss (all p < 0.05). Loss of hip motion was observed in patients with loss of femoral head contour, cam deformity, and acetabular bone loss (all p < 0.001). A decreased joint space was associated with a decreased ΔPFA (p = 0.040). The presence of disc space narrowing, disc space narrowing > two levels, and disc narrowing involving the L5-S1 segment were associated with decreased spinopelvic motion (all p < 0.05). Preoperative hip OA as assessed on an AP pelvic radiograph predicts spinopelvic motion. These data suggest that specific hip osteoarthritic morphological characteristics listed above alter spinopelvic motion to a greater extent than others., Competing Interests: None declared., (© 2023 The British Editorial Society of Bone & Joint Surgery.)

Background: Intraoperative dexamethasone can reduce postoperative pain and nausea following total knee (TKA) and total hip arthroplasty (THA). To the best of our knowledge, no study to date has been adequately powered to detect the risk of periprosthetic joint infection (PJI) from early dexamethasone exposure. This study aimed to assess PJI rates and complications in patients undergoing primary elective TKA and THA who received intraoperative dexamethasone., Methods: A national database was used to identify adults undergoing primary elective TKA and THA between 2015 and 2020. Patients who received intraoperative dexamethasone and those who did not were identified. The primary endpoint was 90-day risk of infectious complications. Secondary end points included thromboembolic, pulmonary, renal, and wound complications. Multivariate analyses were performed to assess the risk of all endpoints between cohorts. Between 2015 and 2020, 1,322,025 patients underwent primary elective TJA, of which 857,496 (64.1%) underwent TKA and 474,707 (35.9%) underwent TKA., Results: In patients who underwent TKA, dexamethasone was associated with lower risk of PJI (adjusted odds ratio: 0.87, 95% CI: 0.82-0.93, P < .001) as well as other secondary endpoints such as pulmonary embolism, deep vein thrombosis, and acute kidney injury. In patients who underwent THA, dexamethasone was associated with a lower risk of PJI (adjusted odds ratio: 0.80, 95% CI: 0.73-0.86, P < .001) as well as other secondary endpoints such as pulmonary embolism, deep vein thrombosis, acute kidney injury, and pneumonia., Conclusion: Intraoperative dexamethasone was not associated with increased risk of infectious complications. The data presented here provide evidence in support of intraoperative dexamethasone utilization during primary TKA or THA., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Study Design: This is a retrospective cohort study of consecutive patients undergoing lumbar spinal fusion (LSF) within the PearlDiver Humana research database from 2010 to 2018., Objective: The aim of this study was to determine if timing of total hip arthroplasty (THA) affects LSF outcomes., Summary of Background Data: In patients with both spine and hip pathology, outcomes of THA have been shown to be affected by the timing of THA relative to LSF. However, few studies have assessed postoperative outcomes following LSF in this clinical scenario., Materials and Methods: A national database was queried for patients undergoing lumbar fusion and divided into 4 groups: (1) those who underwent LSF without THA (No THA); (2) those who underwent THA at least 2 years before LSF (>2 Prior THA); (3) those who underwent THA in the 2 years before LSF (0-2 Prior THA); and (4) those who underwent THA after LSF (THA After). We assessed lumbar-specific outcomes, including pseudarthrosis, revision, mechanical failure, and adjacent segment disease (ASD); as well as systemic complications. Controlling for age, sex, and Charlson comorbidity index, complication rates between all groups were assessed using univariate and multivariate logistic regression analysis. Post hoc comparisons were performed using the Fisher exact test with Bonferroni correction to account for multiple pairwise comparisons, resulting in an adjusted threshold for statistical significance of P<0.007., Results: When compared with the no THA group, those in the THA After group had a higher rate of ASD on multivariate analysis [adjusted odds ratio: 1.53, 95% confidence interval: 1.20-1.94, P<0.001]. When compared with all patients who underwent THA before LSF, patients who underwent THA after LSF had an increased risk of ASD (adjusted odds ratio: 3.80, 95% confidence interval: 2.21-6.98, P<0.001)., Conclusions: Patients who undergo THA after LSF have an increased rate of lumbar-related complications both when compared with patients who do not undergo THA and when compared with patients who undergo THA before LSF., Competing Interests: J.C.W. receives royalties for Biomet, Seaspine, and Synthes; he has investments/options in Bone Biologics, Pearldiver, Electrocore, and Surgitech; he serves on the board of directors for the AO Foundation, Society for Brain Mapping and Therapeutics, and American Orthopaedic Association; he serves on the editorial board for Spine, The Spine Journal, Clinical Spine Surgery, and Global Spine Journal; he receives fellowship funding (paid to institution) from the AO Foundation. N.D.H. is a paid consultant for MicroPort Orthopedics and Intellijoint Surgical and has stock options in Intellijoint Surgical; he serves as a board member for the American Academy of Orthopaedic Surgeons. R.J.H. is a paid consultant for Nuvasive; he serves on the editorial board for The Spine Journal, Clinical Spine Surgery, and Global Spine Journal. The remaining authors declare no conflict of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)