RESUMEN
Background and purpose - Length of hospital stay (LOS) following total hip arthroplasty (THA) has been markedly reduced. Recently, same-day THA (SD-THA) was introduced, and previous studies have indicated satisfactory safety. However, studies are heterogeneous and only a few report results on SD-THA when using a posterolateral surgical approach. Thus, our aim was to evaluate the feasibility of and complications after SD-THA when using a posterolateral approach. Patients and methods - Consecutive patients scheduled for SD-THA between October 2015 and June 2016 were included. Eligibility criteria for SD-THA were: primary THA, motivation for same-day procedure, age > 18 years, ASA I or II, and the presence of a support person who could remain with the patient for 24 hours after surgery. A posterolateral surgical approach was used. Data were collected retrospectively from hospital records and the Danish National Patient Registry. Outcome measures were: complications during admission, LOS, causes of prolonged admission, and prevalence and causes of readmission at 90 days' follow-up. Results - 102 of 116 (88%) patients scheduled for SD-THA were discharged on the day of surgery. The remaining 14 patients were discharged the following day. Primary causes of prolonged admission were: dizziness/nausea, pain, and wound seepage. 7 patients had an estimated blood loss above 400 mL, but all were discharged as planned. No major complications occurred during admission. At follow-up, 3 patients had been readmitted due to pneumonia, wound infection, and dislocation, respectively. Interpretation - The results indicate that SD-THA performed with a posterolateral approach is feasible and can be performed with a low complication rate in a selected group of patients.
Asunto(s)
Procedimientos Quirúrgicos Ambulatorios/efectos adversos , Artroplastia de Reemplazo de Cadera/efectos adversos , Complicaciones Posoperatorias/etiología , Adulto , Anciano , Anciano de 80 o más Años , Procedimientos Quirúrgicos Ambulatorios/métodos , Artroplastia de Reemplazo de Cadera/métodos , Estudios de Cohortes , Vías Clínicas/organización & administración , Estudios de Factibilidad , Femenino , Humanos , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Alta del Paciente , Readmisión del Paciente/estadística & datos numéricos , Estudios RetrospectivosRESUMEN
INTRODUCTION: Recent reports indicate that total hip arthroplasty (THA) can be further accelerated and might be managed as day-case. This could provide benefits to health care expenditure, lower patient risks and change patient satisfaction. We evaluated the feasibility, efficacy, safety and patient satisfaction of same-day (<12 hours) THA operation and discharge. METHODS: Consecutive patients were screened for eligibility (primary THA, ASA 1 or 2 physical status) and the presence of a support person to follow the patient for 48 hours postoperatively in an observational study. THA was managed as day-case (<12 hours) through patient selection, preoperative patient education programme, light spinal anaesthesia, low opioid usage, and early mobilisation. Efficacy and logistics were analysed and compared to current accelerated practice. Patient satisfaction was compared to existing fast-track THA and elective surgery cohorts. RESULTS: 29 consecutive patients were screened and 20 participated (69%). 17/20 patients (85%) were released on the day of surgery. There were no serious adverse events or complications, and no infections or readmission at 6-week follow-up. Patient overall satisfaction rating (1-5) was high (4.75), higher than in a 301-patient cohort (4.53) (THA and total knee arthroplasty) from the same centre (p = 0.23), and higher than in a national, elective surgery cohort (4.3) (p = 0.04). CONCLUSIONS: We report the feasibility of day-case THA. Safety, complications and overall patient acceptance were satisfactory. Light spinal anaesthesia facilitated quick transit through postanaesthesia care unit to early mobilisation. Support persons and patient education may play a part in high patient acceptance of day-case surgery.
Asunto(s)
Procedimientos Quirúrgicos Ambulatorios/métodos , Artroplastia de Reemplazo de Cadera/métodos , Tiempo de Internación , Alta del Paciente , Seguridad del Paciente , Anciano , Artroplastia de Reemplazo de Cadera/efectos adversos , Dinamarca , Procedimientos Quirúrgicos Electivos/métodos , Estudios de Factibilidad , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Monitoreo Fisiológico , Satisfacción del Paciente/estadística & datos numéricos , Selección de Paciente , Estudios Prospectivos , Medición de Riesgo , Resultado del TratamientoRESUMEN
BACKGROUND: Hip resurfacing arthroplasty (HRA) is associated with osteonecrosis of the femoral head and femoral neck fracture, which may be caused by a decrease in the perfusion of the bone initiated at surgery. Several studies have demonstrated a decreased blood flow during surgery depending on the choice of surgical approach. We investigated the effect of the surgical approach on the blood flow and metabolism in the femoral head and neck in HRA by Laser Doppler flowmetry (LDF) and microdialysis. MATERIALS AND METHODS: We conducted a randomized clinical trial on 38 patients, allocated to HRA by either the posterior (Post) or the antero-lateral (AntLat) surgical approach. LDF was performed during surgery and microdialysis after surgery to assess the concentration of the following metabolic markers: glucose, lactate, pyruvate and glycerol. RESULTS: At 44-50 h after surgery, the mean lactate/pyruvate (L/P) and lactate/glucose (L/G) ratio was higher in the Post group compared to the AntLat group; L/P 195.3 (SEM 123) in Post and 128.5 (108.0) in AntLat; L/G 16.9 (6.5) in Post and 8.9 (3.7) in AntLat (p L/P = 0.02 and p L/G = 0.03). There was no difference in the LDF measurements (p = 0.74). INTERPRETATION: HRA in the posterior approach results in increased post-operative ischemia in the femoral head and neck although during surgery, no difference in the blood flow was found. Still, the antero-lateral approach also causes considerable ischemia and other possible explanations, such as damage to the retinacular vessels during surgery or altered microcirculation because of heating from the cementation process, needs to be investigated.
Asunto(s)
Artroplastia de Reemplazo de Cadera/métodos , Cabeza Femoral/irrigación sanguínea , Cuello Femoral/irrigación sanguínea , Isquemia/diagnóstico , Osteoartritis de la Cadera/cirugía , Adulto , Artroplastia de Reemplazo de Cadera/efectos adversos , Femenino , Cabeza Femoral/cirugía , Cuello Femoral/cirugía , Humanos , Isquemia/etiología , Masculino , Microdiálisis , Persona de Mediana Edad , ReologíaRESUMEN
Invasive infection with animal-associated bacteria, Erysipelotrix rhusiopathiae, is unusual and has, to our knowledge, never been described as the cause of infected total hip arthroplasty. We describe how an infected total hip arthroplasty caused by these bacteria is eradicated using standard surgical and antibiotic treatment. Before 2-stage revision surgery, the patient had persistent groin pain, elevated C-reactive protein, radiographic periprosthetic osteolysis, excessive intra-articular fluid, and periprosthetic activity accumulation on the white cell scan. The patient was treated with benzylpenicillin after confirmed sensitivity of E rhusiopathiae diagnosed by culture of five tissue samples and polymerase chain reaction of the prosthetic sonicate sample. Sixteen weeks after the last stage of revision surgery, there were no signs of reoccurring infection.