5 MOST IMPORTANT UPDATES IN HIP REPLACEMENT

5 MOST IMPORTANT UPDATES IN HIP REPLACEMENT

In September 2017, James T. Ninomiya, MD, MS & lead author of September 20, 2017 Specialty Update on Hip Replacement found the top five compelling updates from more than 50 studies that he covers in the paper. 

1) OBESITY & THA OUTCOMES

Although obesity is already a well known risk for perioperative THA complications, a prospective registry-based study has found that reoperation and implant revision or removal rates increase with increasing BMI. In other words, an increasing BMI was found to have a correlation with higher rates of early hip dislocation and deep periprosthetic infection.

2) PREVENTING INFECTION

Patients that have intra-articular injections up to 3 months before THA experienced almost double the risk of periprosthetic infection in the first year following surgery, relative to those in noninjection control groups.

3) SURGICAL APPROACHES TO THA

In a study[1][2], despite claims to the contrary, more than 2,100 patients revealed that there were no differences in dislocation rates between those who underwent THA using the direct anterior approach and a propensity-score matched cohort who underwent THA using posterior approach.[3]

4) OPERATING ROOM TEMPERATURE

It’s commonly suggested that orthopaedic operating room temperatures should be quite high, which can lead to discomfort and tiredness for the surgical team. The optimal room temperature is actually around 19 degrees C while conducting preoperative patient warming and using intraoperative patient warming devices for the ideal comfort combination.

5) DRIVING

A common question patients ask is when they can drive again. The mean time that was found in the meta-analysis of 19 studies concluded that the mean time for returning to baseline reaction time to break was 2 weeks following a right side hip replacement, and 4 weeks for a right side knee replacement.[4] That being said, recommendations around returning to drive should be personalized for every patient as every case is different.

[1] Schairer WW, Nwachukwu BU, Mayman DJ, Lyman S, Jerabek SA. Preoperative hip injections increase the rate of periprosthetic infection after total hip arthroplasty. J Arthroplasty. 2016 ;31(9)(Suppl):166–169.e1. Epub 2016 Apr 22.

[2] Werner BC, Cancienne JM, Browne JA. The timing of total hip arthroplasty after intraarticular hip injection affects postoperative infection risk. J Arthroplasty. 2016 ;31(4):820–3. Epub 2015 Sep 1.

[3] Maratt JD, Gagnier JJ, Butler PD, Hallstrom BR, Urquhart AG, Roberts KC. No difference in dislocation seen in anterior vs posterior approach total hip arthroplasty. J Arthroplasty. 2016 ;31(9)(Suppl):127–30. Epub 2016 Mar 15.

[4] van der Velden CA, Tolk JJ, Janssen RPA, Reijman M. When is it safe to resume driving after total hip and total knee arthroplasty? A meta-analysis of literature on post-operative brake reaction times. Bone Joint J. 2017 ;99-B(5):566–76.