Effects of Perioperative Selective Serotonin Reuptake Inhibitor Use in Primary Total Hip and Knee Arthroplasty.

BACKGROUND: The aim of this study is to compare functional outcomes and perioperative complications between patients on a selective serotonin reuptake inhibitor (SSRI) and those who are not on an SSRI preoperatively at the time of total joint arthroplasty. METHODS: A retrospective study was performed on 28,386 patients who received a primary total hip (THA) or knee (TKA) arthroplasty. Patients were compared based on SSRI utilization. We measured patient-reported function and health-related quality of life using the Western Ontario and McMaster Universities Arthritis Index (WOMAC) and the EuroQol-5 Dimensions (EQ-5D-5L) instruments. Chi-squared test was used to compare categorical variables and t-test was used to compare the continuous variables of 2 study groups. RESULTS: Patients on SSRIs have lower preoperative baseline WOMAC and EQ-5D-5L scores than those not using SSRI (P < .001). Patient-reported outcomes improved significantly following surgery, but functional outcome scores remained inferior in patients using SSRI. After adjusting for baseline variables, SSRI use in TKA predicted lower EQ-5D-5L scores than non-SSRI users (P = .036) while the WOMAC scores were not different (P = .118). For the THA cohort, SSRI use predicted lower EQ-5D-5L (P = .001) and WOMAC scores than non-SSRI users (P = .008). SSRI use was associated with increased transfusion rate, length of stay, readmission rate, and medical events. About 11.3% of TKA and 13.3% of THA patients stopped using SSRI at 12 months after arthroplasty. CONCLUSION: Patients using an SSRI show improvement comparable to patients not on an SSRI, but their 12-month functional scores continue to be inferior. SSRI utilization was associated with increased adverse events including needing a blood transfusion.

Assessment of risk factors for early-onset deep surgical site infection following primary total hip arthroplasty for osteoarthritis.

The aim of this study was to determine the incidence, annual trend, and perioperative outcomes and identify risk factors of early-onset ( ≤ 90  d) deep surgical site infection (SSI) following primary total hip arthroplasty (THA) for osteoarthritis. We performed a retrospective study using prospectively collected patient-level data from January 2013 to March 2020. The diagnosis of deep SSI was based on the published Centre for Disease Control/National Healthcare Safety Network (CDC/NHSN) definition. The Mann-Kendall trend test was used to detect monotonic trends. Secondary outcomes were 90 d mortality and 90 d readmission. A total of 22 685 patients underwent primary THA for osteoarthritis. A total of 46 patients had a confirmed deep SSI within 90 d of surgery representing a cumulative incidence of 0.2 %. The annual infection rate decreased over the 7-year study period ( p = 0.026 ). Risk analysis was performed on 15 466 patients. Risk factors associated with early-onset deep SSI included a BMI  >  30 kg m - 2 (odds ratio (OR) 3.42 [95 % CI 1.75-7.20]; p < 0.001 ), chronic renal disease (OR, 3.52 [95 % CI 1.17-8.59]; p = 0.011 ), and cardiac illness (OR, 2.47 [1.30-4.69]; p = 0.005 ), as classified by the Canadian Institute for Health Information. Early-onset deep SSI was not associated with 90 d mortality ( p = 0.167 ) but was associated with an increased chance of 90 d readmission ( p < 0.001 ). This study establishes a reliable baseline infection rate for early-onset deep SSI after THA for osteoarthritis through the use of a robust methodological process. Several risk factors for early-onset deep SSI are potentially modifiable, and therefore targeted preoperative interventions of patients with these risk factors is encouraged.

Impact of preoperative mental health status on functional outcome 1 year after total hip arthroplasty

Background: The aim of this prospective cohort study was to determine the effect of preoperative mental health status on functional outcome 1 year after total hip arthroplasty (THA). Methods: Data were collected for 677 patients from a randomized controlled trial in Alberta who received primary THA between April 2005 and June 2006 (sex, age, body mass index [BMI], comorbidities, back pain and need for another lower limb arthroplasty procedure within 1 yr after surgery). The Western Ontario and McMaster University Osteoarthritis Index (WOMAC) and 36-Item Short Form Health Survey (SF-36) mental health component were administered before surgery and 1 year after. We conducted multiple linear regression to determine the effect of mental health on the WOMAC score at 1 year. Results: The mean WOMAC and SF-36 mental health scores were significantly increased at 1 year (p < 0.001 and p = 0.01, respectively). There was a strong correlation between improvement in WOMAC score at 1 year and presurgery SF-36 mental health score (0.13, 95% confidence interval [CI] 0.06 to 0.2). Age (­0.34, 95% CI ­0.45 to ­0.24), obesity (­2.9, 95% CI ­5.32 to ­0.4), back pain (­5.75, 95% CI ­8.04 to ­3.46) and awaiting another joint arthroplasty operation (­6.18, 95% CI ­8.9 to ­3.47) had a negative impact on the WOMAC score. Conclusion: There was a strong correlation between presurgery mental health and the resolution of pain and improved functioning 1 year after THA. We recommend that patients receive appropriate counselling and, where appropriate, medical therapy before THA.

Contexte: Le but de cette étude de cohorte prospective était de déterminer l'effet de l'état de santé mentale préopératoire sur les résultats fonctionnels une année après une intervention pour prothèse totale de la hanche (PTH). Méthodes: Les données concernant 677 patients opérés pour PTH entre avril 2005 et juin 2006 ont été recueillies à partir d'un essai randomisé et contrôlé albertain (sexe, âge, indice de masse corporelle [IMC], comorbidités, dorsalgie et autre arthroplastie d'un membre inférieur requise dans l'année suivant l'intervention). L'indice WOMAC (Western Ontario and McMaster University Osteoarthritis Index) et le volet santé mentale du questionnaire SF-36 (36-Item Short Form Health Survey) ont été administrés avant la chirurgie, puis 1 an après. Nous avons réalisé une analyse de régression linéaire multiple pour déterminer l'effet de la santé mentale sur l'indice WOMAC après 1 an. Résultats: Les scores WOMAC et volet santé mentale du SF-36 étaient significativement plus élevé après 1 an (p < 0,001 et p = 0,01, respectivement). On a noté une forte corrélation entre l'amélioration du score WOMAC après 1 an et le score au volet santé mentale du SF-36 préopératoire (0,13, intervalle de confiance [IC] de 95 % 0,06 à 0,2). L'âge (­0,34, IC de 95 % ­0,45 à ­0,24), l'obésité (­2,9, IC de 95 % ­5,32 à ­0,4), la dorsalgie (­5,75, IC de 95 % ­8,04 à ­3.46) et l'attente d'une autre arthroplastie (­6,18, IC de 95 % ­8,9 à ­3,47) ont eu un impact négatif sur le score WOMAC. Conclusion: On a observé une forte corrélation entre l'état de santé mentale préopératoire et la résolution de la douleur/amélioration du fonctionnement un an après la PTH. Nous recommandons un counselling approprié et selon le cas un traitement médical avant la PTH.

Association between Allogeneic Blood Transfusion and Wound Infection after Total Hip or Knee Arthroplasty: A Retrospective Case-Control Study.

Background: To assess using a retrospective case control study, whether patients undergoing primary, elective total hip or knee arthroplasty who receive blood transfusion have a higher rate of post-operative infection compared to those who do not. Materials and Methods: Data on elective primary total hip or knee arthroplasty patients, including patient characteristics, co-morbidities, type and duration of surgery, blood transfusion, deep and superficial infection was extracted from the Alberta Bone and Joint Health Institute (ABJHI). Logistic regression analysis was used to compare deep infection and superficial infection in blood-transfused and non-transfused cohorts. Results: Of the 27892 patients identified, 3098 (11.1%) received blood transfusion (TKA 9.7%; THA 13.1%). Overall, the rate of superficial infection (SI) was 0.5% and deep infection (DI) was 1.1%. The infection rates in the transfused cohort were SI 1.0% and DI 1.6%, and in the non-transfused cohort were SI 0.5% and DI 1.0%. The transfused cohort had an increased risk of superficial infection (adjusted odds ratio (OR) 1.9 [95% CI 1.2-2.9, p-value 0.005]) as well as deep infection (adjusted OR 1.6 [95% CI 1.1-2.2, p-value 0.008]). Conclusion: The odds of superficial and deep wound infection are significantly increased in primary, elective total hip and knee arthroplasty patients who receive blood transfusion compared to those who did not. This study can potentially help in reducing periprosthetic hip or knee infections.

Concordance between laboratories in metal ion testing in patients with metal-on-metal hip implants.

BACKGROUND: Testing of whole blood or serum metal ion levels has become an important part of assessing and monitoring the performance of metal-on-metal bearings, both in hip resurfacing arthroplasty and in total hip replacement. The aim of this study was to determine the concordance between 2 laboratories testing cobalt and chromium ion levels in patients with metal-on-metal bearings. METHODS: Serum and whole blood samples from patients who had undergone metal-on-metal resurfacing or large-diameter total hip arthroplasty were tested for cobalt and chromium ions in laboratory A (a recognized laboratory) and laboratory B (tasked with testing clinical specimens). Laboratory A performed cobalt and chromium testing on whole blood, and laboratory B performed cobalt testing on whole blood and chromium testing on serum. RESULTS: Samples from 104 patients were tested. Laboratory B reported lower whole blood cobalt levels than laboratory A. Furthermore, laboratory A reported that all patients had elevated whole blood cobalt ion levels compared to the normal reference values for the laboratory, whereas laboratory B reported that 46 patients (44.2%) had whole blood cobalt ion levels within the normal reference range for the laboratory. CONCLUSION: This comparative study highlights the importance of using a single laboratory for metal ion testing, as values generated from different laboratories may not be directly comparable. With recent literature suggesting that whole blood cobalt levels as low as 1 ppb may be a predictor of adverse reactions to metal debris, accurate clinical measurement needs to be increasingly exact.

CONTEXTE: Le dosage sanguin ou sérique d'ions métalliques est devenu une étape importante de l'évaluation et du suivi des prothèses à couple de frottement métal-métal utilisées en arthroplastie de resurfaçage ou totale de la hanche. La présente étude visait à évaluer la concordance entre les résultats de 2 laboratoires pour le dosage du cobalt et du chrome chez des patients porteurs de ces prothèses. MÉTHODES: Des prélèvements de sérum et de sang entier de patients porteurs d'une prothèse de resurfaçage ou d'une prothèse totale à grand diamètre de hanche à couple métal-métal ont été expédiés au laboratoire A (un laboratoire reconnu) et au laboratoire B (spécialisé en analyse d'échantillons cliniques) pour le dosage des ions cobalt et chrome. Le laboratoire A a effectué toutes ses analyses sur des prélèvements de sang entier, et le laboratoire B a utilisé le sang entier pour le dosage du cobalt et le sérum pour le dosage du chrome. RÉSULTATS: Les prélèvements de 104 patients ont été analysés. Le laboratoire B a détecté des taux sanguins de cobalt inférieurs à ceux du laboratoire A. De plus, le laboratoire A a indiqué que tous les patients présentaient des taux de cobalt sanguins élevés par rapport à ses valeurs de référence, alors que le laboratoire B a déterminé que le taux de cobalt sanguin de 46 patients (44,2 %) se trouvait dans sa fourchette de valeurs de référence normales. CONCLUSION: Cette étude comparative vient souligner l'importance de choisir un seul laboratoire pour le dosage des ions métalliques, car les valeurs générées par des établissements différents pourraient ne pas être directement comparables. Comme des études récentes semblent indiquer que des taux de cobalt sanguins aussi faibles que 1 p. p. milliard pourraient être des prédicteurs de réaction indésirable aux débris métalliques, la précision et l'exactitude des mesures cliniques revêtent une importance croissante.

Does bearing size influence metal ion levels in large-head metal-on-metal total hip arthroplasty? A comparison of three total hip systems.

BACKGROUND: The purpose of the study was twofold: first, to determine whether there is a statistically significant difference in the metal ion levels among three different large-head metal-on-metal (MOM) total hip systems. The second objective was to assess whether position of the implanted prostheses, patient demographics or factors such as activity levels influence overall blood metal ion levels and whether there is a difference in the functional outcomes between the systems. METHODS: In a cross-sectional cohort study, three different metal-on-metal total hip systems were assessed: two monoblock heads, the Durom socket (Zimmer, Warsaw, IN, USA) and the Birmingham socket (Smith and Nephew, Memphis, TN, USA), and one modular metal-on-metal total hip system (Pinnacle, Depuy Orthopedics, Warsaw, IN, USA). Fifty-four patients were recruited, with a mean age of 59.7 years and a mean follow-up time of 41 months (12 to 60). Patients were evaluated clinically, radiologically and biochemically. Statistical analysis was performed on all collected data to assess any differences between the three groups in terms of overall blood metal ion levels and also to identify whether there was any other factor within the group demographics and outcomes that could influence the mean levels of Co and Cr. RESULTS: Although the functional outcome scores were similar in all three groups, the blood metal ion levels in the larger monoblock large heads (Durom, Birmingham sockets) were significantly raised compared with those of the Pinnacle group. In addition, the metal ion levels were not found to have a statistically significant relationship to the anteversion or abduction angles as measured on the radiographs. CONCLUSIONS: When considering a MOM THR, the use of a monoblock large-head system leads to higher elevations in whole blood metal ions and offers no advantage over a smaller head modular system.