A Trend for Increased Risk of Revision Surgery due to Deep Infection following Fast-Track Hip Arthroplasty

doi:10.1155/2016/7901953

. 2016:2016:7901953.

doi: 10.1155/2016/7901953. Epub 2016 Feb 29.

A Trend for Increased Risk of Revision Surgery due to Deep Infection following Fast-Track Hip Arthroplasty

Einar Amlie¹, Anners Lerdal², Caryl L Gay³, Øystein Høvik¹, Lars Nordsletten⁴, Sigbjørn Dimmen¹

Affiliations

¹ Orthopedic Research Group, Lovisenberg Diakonale Hospital, Nydalen, P.O. Box 4970, 0440 Oslo, Norway.
² Orthopedic Research Group, Lovisenberg Diakonale Hospital, Nydalen, P.O. Box 4970, 0440 Oslo, Norway; Department of Nursing Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, Blindern, P.O. Box 1130, 0450 Oslo, Norway.
³ Orthopedic Research Group, Lovisenberg Diakonale Hospital, Nydalen, P.O. Box 4970, 0440 Oslo, Norway; Department of Family Health Care Nursing, University of California, San Francisco, Box 0606, San Francisco, CA 94143, USA.
⁴ Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Nydalen, P.O. Box 4956, 0450 Oslo, Norway; Oslo University Hospital, University of Oslo, 0450 Oslo, Norway.

PMID: 27034841
PMCID: PMC4789358
DOI: 10.1155/2016/7901953

A Trend for Increased Risk of Revision Surgery due to Deep Infection following Fast-Track Hip Arthroplasty

Einar Amlie et al. Adv Orthop. 2016.

. 2016:2016:7901953.

doi: 10.1155/2016/7901953. Epub 2016 Feb 29.

Authors

Einar Amlie¹, Anners Lerdal², Caryl L Gay³, Øystein Høvik¹, Lars Nordsletten⁴, Sigbjørn Dimmen¹

Affiliations

¹ Orthopedic Research Group, Lovisenberg Diakonale Hospital, Nydalen, P.O. Box 4970, 0440 Oslo, Norway.
² Orthopedic Research Group, Lovisenberg Diakonale Hospital, Nydalen, P.O. Box 4970, 0440 Oslo, Norway; Department of Nursing Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, Blindern, P.O. Box 1130, 0450 Oslo, Norway.
³ Orthopedic Research Group, Lovisenberg Diakonale Hospital, Nydalen, P.O. Box 4970, 0440 Oslo, Norway; Department of Family Health Care Nursing, University of California, San Francisco, Box 0606, San Francisco, CA 94143, USA.
⁴ Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Nydalen, P.O. Box 4956, 0450 Oslo, Norway; Oslo University Hospital, University of Oslo, 0450 Oslo, Norway.

PMID: 27034841
PMCID: PMC4789358
DOI: 10.1155/2016/7901953

Abstract

Rates of revision surgery due to deep infection following total hip arthroplasty (THA) increased at a Norwegian hospital following implementation of fast-track procedures. The purpose of this study was to determine whether selected demographic (age and sex) and clinical (body mass index, American Society of Anesthesiologists (ASA) classification, surgery duration, length of hospital stay, cemented versus uncemented prosthesis, and fast-track procedures) factors were associated with higher risk of revision surgery due to deep infection following THA. In a prospective designed study 4,406 patients undergoing primary THA between January 2001 and January 2013 where included. Rates of infection-related revision surgery within 3 months of THA were higher among males and among patients who received fast-track THA. Adjusting for sex and age, the implemented fast-track elements were significantly associated with increased risk of revision surgery. Risk of infection-related revision surgery was unrelated to body mass index, physical status, surgery duration, length of hospital stay, and prosthesis type. Because local infiltration analgesia, drain cessation, and early mobilization were introduced in combination, it could not be determined which component or combination of components imposed the increased risk. The findings in this small sample raise concern about fast-track THA but require replication in other samples.

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Figures

**Figure 1**
Rates of revision surgery due to deep infection following primary THA based on continuous quality surveillance data. The 6-month period during which the full fast-track protocol was implemented had a significantly higher rate of revision surgery due to deep infection within 3 months of the primary THA surgery. Infection-related revision surgery rates during the periods before and after the fast-track protocol was implemented were not significantly different. Surgeries including only partial implementation of the fast-track procedures (performed Jan to Apr 2010) were excluded from the analysis.

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References

1. Antrobus J. D., Bryson G. L. Enhanced recovery for arthroplasty: good for the patient or good for the hospital? Canadian Journal of Anesthesia. 2011;58(10):891–896. doi: 10.1007/s12630-011-9564-9. - DOI - PubMed
1. McDonald D. A., Siegmeth R., Deakin A. H., Kinninmonth A. W. G., Scott N. B. An enhanced recovery programme for primary total knee arthroplasty in the United Kingdom—follow up at one year. Knee. 2012;19(5):525–529. doi: 10.1016/j.knee.2011.07.012. - DOI - PubMed
1. Husted H., Lunn T. H., Troelsen A., Gaarn-Larsen L., Kristensen B. B., Kehlet H. Why still in hospital after fast-track hip and knee arthroplasty? Acta Orthopaedica. 2011;82(6):679–684. doi: 10.3109/17453674.2011.636682. - DOI - PMC - PubMed
1. Husted H., Jensen C. M., Solgaard S., Kehlet H. Reduced length of stay following hip and knee arthroplasty in Denmark 2000–2009: from research to implementation. Archives of Orthopaedic and Trauma Surgery. 2012;132(1):101–104. doi: 10.1007/s00402-011-1396-0. - DOI - PubMed
1. Andersen L. Ø., Otte K. S., Husted H., Gaarn-Larsen L., Kristensen B., Kehlet H. High-volume infiltration analgesia in bilateral hip arthroplasty. A randomized, double-blind placebo-controlled trial. Acta Orthopaedica. 2011;82(4):423–426. doi: 10.3109/17453674.2011.596063. - DOI - PMC - PubMed

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[1] Antrobus J. D., Bryson G. L. Enhanced recovery for arthroplasty: good for the patient or good for the hospital? Canadian Journal of Anesthesia. 2011;58(10):891–896. doi: 10.1007/s12630-011-9564-9. - DOI - PubMed

[2] Antrobus J. D., Bryson G. L. Enhanced recovery for arthroplasty: good for the patient or good for the hospital? Canadian Journal of Anesthesia. 2011;58(10):891–896. doi: 10.1007/s12630-011-9564-9. - DOI - PubMed

[3] McDonald D. A., Siegmeth R., Deakin A. H., Kinninmonth A. W. G., Scott N. B. An enhanced recovery programme for primary total knee arthroplasty in the United Kingdom—follow up at one year. Knee. 2012;19(5):525–529. doi: 10.1016/j.knee.2011.07.012. - DOI - PubMed

[4] McDonald D. A., Siegmeth R., Deakin A. H., Kinninmonth A. W. G., Scott N. B. An enhanced recovery programme for primary total knee arthroplasty in the United Kingdom—follow up at one year. Knee. 2012;19(5):525–529. doi: 10.1016/j.knee.2011.07.012. - DOI - PubMed

[5] Husted H., Lunn T. H., Troelsen A., Gaarn-Larsen L., Kristensen B. B., Kehlet H. Why still in hospital after fast-track hip and knee arthroplasty? Acta Orthopaedica. 2011;82(6):679–684. doi: 10.3109/17453674.2011.636682. - DOI - PMC - PubMed

[6] Husted H., Lunn T. H., Troelsen A., Gaarn-Larsen L., Kristensen B. B., Kehlet H. Why still in hospital after fast-track hip and knee arthroplasty? Acta Orthopaedica. 2011;82(6):679–684. doi: 10.3109/17453674.2011.636682. - DOI - PMC - PubMed

[7] Husted H., Jensen C. M., Solgaard S., Kehlet H. Reduced length of stay following hip and knee arthroplasty in Denmark 2000–2009: from research to implementation. Archives of Orthopaedic and Trauma Surgery. 2012;132(1):101–104. doi: 10.1007/s00402-011-1396-0. - DOI - PubMed

[8] Husted H., Jensen C. M., Solgaard S., Kehlet H. Reduced length of stay following hip and knee arthroplasty in Denmark 2000–2009: from research to implementation. Archives of Orthopaedic and Trauma Surgery. 2012;132(1):101–104. doi: 10.1007/s00402-011-1396-0. - DOI - PubMed

[9] Andersen L. Ø., Otte K. S., Husted H., Gaarn-Larsen L., Kristensen B., Kehlet H. High-volume infiltration analgesia in bilateral hip arthroplasty. A randomized, double-blind placebo-controlled trial. Acta Orthopaedica. 2011;82(4):423–426. doi: 10.3109/17453674.2011.596063. - DOI - PMC - PubMed

[10] Andersen L. Ø., Otte K. S., Husted H., Gaarn-Larsen L., Kristensen B., Kehlet H. High-volume infiltration analgesia in bilateral hip arthroplasty. A randomized, double-blind placebo-controlled trial. Acta Orthopaedica. 2011;82(4):423–426. doi: 10.3109/17453674.2011.596063. - DOI - PMC - PubMed

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A Trend for Increased Risk of Revision Surgery due to Deep Infection following Fast-Track Hip Arthroplasty

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A Trend for Increased Risk of Revision Surgery due to Deep Infection following Fast-Track Hip Arthroplasty

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