More surgery – more complications, less success
Hip Replacement after Spinal Fusion – more complications, less success
Researchers at the University of California at San Francisco examined patients with degenerative hip disease and degenerative disc disease to see how these patients did with hip replacement after the had already undergone a spinal fusion.
Here is their conclusion: Patients with preexisting lumbar spine fusion experience worse early outcomes after primary hip replacement including higher rates of complications and reoperation. Lower rates of neuraxial anesthesia (nerve blocks) and increased narcotic usage represent potential contributors. The complex interplay between the lumbar spine and hip warrants attention and further investigation.1
Go home after revision surgery to avoid unplanned rehospitalization
According to researchers at Mt. Sinai hospital in New York, patients who go to a nursing home or other institutionalized care following a revision joint surgery were more likely to have an unanticipated return to the hospital within 30 days.
Here is the conclusion: Revision Joint Repair patients who are discharged to skilled nursing facility or inpatient rehabilitation facility have significantly increased risk for unplanned readmissions as compared with patients discharged home.
Across risk levels, home discharge destination (when feasible) is the optimal strategy.2
3 in 1000 patients will have their leg amputated because of failed knee replacement
This is research from the Department of Orthopedic Surgery, Copenhagen University Hospital Herlev-Gentofte, Hellerup, Denmark.
Transfemoral (above the knee) amputation is considered the last treatment option for failed knee arthroplasty. This study presented evidence for the leading causes of knee replacement failre leading to the need for amputation.
The causes of the amputation were:
- infection aroung the implant (83%),
- soft-tissue deficiency surrounding the implant (23%),
- severe bone loss (18%),
- extensor mechanism disruption, i.e., patellar and quadricep tendon disruption (10%),
- intractable pain (10%),
- fracture around the implant (9%),
- circulatory damage (8%).
In 80% of the cases, there were more than 2 of these factors for amputation.3
1 Barry JJ Sing DC, Vail TP, Hansen EN. Early Outcomes of Primary Total Hip Arthroplasty After Prior Lumbar Spinal Fusion. J Arthroplasty. 2016 Aug 8. pii: S0883-5403(16)30441-7. doi: 10.1016/j.arth.2016.07.019. [Epub ahead of print]
2 Keswani A, Weiser MC, Shin J, Lovy AJ, Moucha CS. Discharge Destination After Revision Total Joint Arthroplasty: An Analysis of Postdischarge Outcomes and Placement Risk Factors. J Arthroplasty. 2016 Sep;31(9):1866-1872.e1. doi: 10.1016/j.arth.2016.02.053.
3 Gottfriedsen TB1, Schrøder HM, Odgaard A. Transfemoral Amputation After Failure of Knee Arthroplasty: A Nationwide Register-Based Study. J Bone Joint Surg Am. 2016 Dec 7;98(23):1962-1969.