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Background The number of total hip arthroplasties (THA) being performed has been steadily increasing for decades. With increased primary THA surgical volume, revision THA numbers are also increasing at a steady pace. With the aging, increasingly comorbid patient populations and newly imposed financial penalties for hospitals with high readmission rates, refining understanding of factors influencing readmission following THA is a research priority. We hypothesize that numerous preoperative medical comorbidities and postoperative medical complications will emerge as significant positive risk factors for 30-day readmission. Methods ACS-NSQIP database identified patients who underwent revision THA from 2005 to 2015. The primary outcome assessed was hospital readmission within 30 days. Patient demographics, preoperative comorbidities, laboratory studies, operative characteristics, and postsurgical complications were compared between readmitted and non-readmitted patients. Logistic regression identified significant independent risk factors for 30-day readmission among these variables. Results 10,032 patients underwent revision THA in the ACS-NSQIP from 2005 to 2015; 855 (8.5%) were readmitted within 30-days. Increasing age, the presence of preoperative comorbidities, high ASA class, and increased operative time were significant positively associated independent risk factors for 30-day readmission. Several postoperative medical and surgical complications such as myocardial infarction, stroke, pneumonia, and sepsis demonstrated significant positive associations with readmission. Conclusion Identifying and understanding risk factors associated with readmission allows for the implementation of evidence-based interventions aimed at minimizing risk and reducing 30-day readmission rates following revision THA. © 2018 Delhi Orthopedic Association. All rights reserved.Background For the removal of well fixed femoral stems, various standard and extended approaches are possible, all of which have their advantages and disadvantages. They should allow good visualization and avoid uncontrolled damage to the bone (especially devascularization and fractures) and to the musculature (especially the gluteus medius). As an extended approach we prefer the transfemoral approach in a modified Wagner technique. It is indicated for the controlled removal of broken endoprosthetic stems, a significantly thinned bone at risk of fracture, a stable cement mantle, a partially fixed cementless prosthetic stem with a coarse, rough surface, and infected, fixed total hip endoprostheses. In this review article we describe our experience with our technique of the transfemoral approach. Material and results In 68 patients with hip revisions using the modified transfemoral approach, the Harris Hip Score increased continuously from 41.4 points preoperatively to 85.9 points 24 months postoperatively. The bony flap showed bone consolidation in 98.5% of cases. In 76 patients with transfemoral two-stage septic hip revisions, with closure of the flap around the interim prosthesis with cerclage wires and reopening of the flap during second stage revision, the Harris Hip Score was 62.2 ± 12.6 points before the replacement of the spacer and 86.6 ± 15.5 points two years after reimplantation. The healing rate of the bony flap after reimplantation was 98.7%, the absence of infection 93.4%, the rate of stem subsidence 6.6%, and the dislocation rate 6.6%; there was no aseptic loosening of the implants. Conclusion The transfemoral approach allows a reliable protection of the gluteus medius and the vastogluteal sling, and enables reproducibly good clinical outcomes. © 2019 Delhi Orthopedic Association. All rights reserved.The number of total hip arthroplasty (THA) procedures performed annually continues to rise. Specific challenges, including acetabular bone loss, are commonly encountered at the time of revision surgery, and orthopaedic surgeons must be prepared to address them. This review focuses on topics related to acetabular reconstruction, including pre-operative patient evaluation (clinical and radiographic), pre-operative planning, common causes of acetabular failure, classification of acetabular bone loss, methods of acetabular reconstruction, and clinical results based on reconstruction method. Pre-operative patient evaluation for revision THA begins with a thorough history and physical examination as well as laboratory workup to rule out infection. Detailed radiographic evaluation and pre-operative planning are also essential and will facilitate communication amongst all members of the operative team. Although there are several ways to describe acetabular bone loss, the Paprosky classification system - defined by anterosuperior and posteroinferior acetabular column integrity - is the system most commonly used today and will guide treatment strategy. Several treatment strategies have been developed and may be termed either "cemented" (e.g. impaction grafting, ring and cage construction, structural allograft) or "uncemented" (e.g. hemispheric shell ± porous metal augment, cup-cage, custom triflange acetabular component). Although each strategy has its advantages and disadvantages, the general principles remain the same. Successful treatment depends upon detailed pre-operative assessment, planning, and team-based plan execution. Uncemented techniques that allow for biologic fixation are preferred. https://www.selleckchem.com/products/azd0156-azd-0156.html In the special case of pelvic discontinuity, acetabular distraction is the authors' preferred technique. Longer term studies are still needed to evaluate the longevity of each of the various reconstruction methods presented. © 2019 Delhi Orthopedic Association. All rights reserved.Periprosthetic fracture can create significant morbidity in the arthroplasty population. Patients with periprosthetic fracture have been shown to have worse outcomes and higher mortality than patients undergoing elective revision THA. In this review, we will focus on Vancouver B2 and B3 fractures. Both of these fracture types are associated with a loose primary prosthesis and warrant revision surgery. There are many different options for fixation choice of the femoral prosthesis, and preference has been evolving over the last 30 years. Currently, we use monoblock, tapered, fluted, titanium stems for all periprosthetic fracture revision surgeries. © 2019.
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