Risk of Acute Kidney Injury After Primary and Revision Total Hip Arthroplasty and Total Knee Arthroplasty Using a Multimodal Approach to Perioperative Pain Control Including Ketorolac and Celecoxib.

Safe and effective perioperative analgesia is instrumental to patient satisfaction and decreasing LOS after TJA. We evaluated rates of acute kidney injury (AKI) in primary and revision TJA using a multimodal pain control regimen including scheduled celecoxib and PRN ketorolac. Postoperative AKI was identified in 43/903 (4.8%) of 903 of patients with adequate preoperative renal function. Those who developed AKI had significantly increased LOS (P < .01), were older, more obese, and more likely to have diabetes (P < .05). With a protocol incorporating NSAIDs in patients without evidence of preoperative renal impairment, there is a 4.8% rate of AKI, which is 2.7 times higher than the reported literature. Acute postoperative kidney injury was significantly correlated with increased LOS and has important patient safety and healthcare-related cost implications.

Thirty-five-year results after Charnley total hip arthroplasty in patients less than fifty years old. A concise follow-up of previous reports.

We report the updated results for a previously described cohort of patients who were less than fifty years old at the time of the index Charnley total hip arthroplasty with cement. The original cohort consisted of ninety-three consecutive hips in sixty-nine patients. The patients were followed for a minimum of thirty-five years after surgery or until death. At the latest follow-up evaluation, there were forty-one total hip replacements (44%) in thirty-two living patients. Thirty-four (37%) of the ninety-three total hip replacements in the original cohort had been revised or removed. Twenty acetabular (22%) and seven femoral (8%) components had been revised for aseptic loosening. Since the twenty-five-year follow-up, the average six-minute-walk distance decreased from 395 m to 171 m, and this decrease correlated with increasing comorbidity. This study demonstrates the durability of cemented total hip replacements in a young patient population. Although 63% (fifty-nine) of the ninety-three original hip replacements were functioning at the latest follow-up or at the time of death, a significant decrease in activity level was seen over time (p < 0.001). Of the forty-one original implants in the patients who were alive at the time of the thirty-five-year follow-up, only 46% (nineteen) were retained.

Cementless THA for the treatment of osteonecrosis at 10-year follow-up: have we improved compared to cemented THA?

Results of cementless THA for osteonecrosis were evaluated at a minimum of 10-year follow-up and compared to our previous report of cemented THA for osteonecrosis. Eighty cementless THAs in 66 patients with osteonecrosis were followed for a minimum of 10 years. Evaluation consisted of need for revision; radiographic evidence of loosening, wear and osteolysis; activity monitoring with an accelerometer; UCLA, Tegner, WOMAC, and Harris hip scores. Results were compared to 48 cemented THAs performed for osteonecrosis with comparable follow-up. At a minimum of 10 years, 10 hips required reoperation. Loosening and revision for loosening were significantly lower in the cementless group compared to the cemented historical control. Cementless fixation in THAs for osteonecrosis demonstrated durable results with bearing surface wear being the major long-term problem.

Cementless total hip arthroplasty in patients fifty years of age or younger: a minimum ten-year follow-up.

BACKGROUND: The durability of total hip arthroplasty in younger patients has been reported to be less than that in older patients. The purpose of this study was to evaluate the results of cementless total hip arthroplasty performed in a consecutive series of patients fifty years of age or younger who were followed for a minimum of ten years. METHODS: We prospectively followed 100 consecutive patients (115 hips) who were fifty years of age or younger when they were treated with primary cementless total hip arthroplasty with use of a second-generation, extensively porous-coated femoral stem and a cementless acetabular component. The patients were followed for a minimum of ten years, and the results were compared with our patients in the same age group who had total hip arthroplasty with cement. Evaluation included the need for revision, activity questionnaires, six-minute walks, activity level monitoring with an accelerometer, and radiographic evaluation for evidence of loosening, wear, and osteolysis. RESULTS: Seventy-three patients (eighty-two hips) were available for follow-up at ten years (mean, twelve years). Seventeen patients (twenty-three hips) had died, and ten patients (ten hips) were lost to follow-up. The average age at the time of surgery was 40.1 years. Three femoral stems were revised for periprosthetic fracture. No acetabular shell or femoral stem was revised for loosening, and none were loose on radiographs made at the time of a minimum ten-year follow-up. This compares favorably with the cemented cohort, which had poorer survivorship of the implant with regard to revision for aseptic loosening and radiographic loosening. Reoperation for any reason was similar between the two cohorts at ten years, primarily because of the relatively large numbers of revisions for polyethylene wear in the cementless group. CONCLUSIONS: Cementless total hip arthroplasty with use of a second-generation, extensively porous-coated stem demonstrated durable fixation in an active, younger population at a minimum follow-up of ten years and had better survivorship with respect to fixation compared with our previously reported cemented cohort.