The Rate of Postoperative Infections in Patients with Total Hip Replacement Done In Ayub Teaching Hospital, Abbottabad: Postoperative Infections in Total Hip Replacement

Syed Usman Shah; Mohammad Younas; Abid Ur Rehman; Amina Gul Shehzar Khan; Muhammad Shoaib Zardad; Shahzad Ahmad; Ratib Kamal

doi:10.54393/pjhs.v5i10.2177

Authors

Syed Usman Shah Department of Orthopedics, Ayub Teaching Hospital, Abbottabad, Pakistan
Mohammad Younas Department of Orthopedics, Ayub Teaching Hospital, Abbottabad, Pakistan
Abid Ur Rehman Department of Orthopedics, Ayub Teaching Hospital, Abbottabad, Pakistan
Amina Gul Shehzar Khan Department of Orthopedics, Ayub Teaching Hospital, Abbottabad, Pakistan
Muhammad Shoaib Zardad Department of Orthopedics, Ayub Teaching Hospital, Abbottabad, Pakistan
Shahzad Ahmad Department of Orthopedics, Ayub Teaching Hospital, Abbottabad, Pakistan
Ratib Kamal Ayub Teaching Hospital, Abbottabad, Pakistan

DOI:

https://doi.org/10.54393/pjhs.v5i10.2177

Keywords:

Total Hip Replacement, Post-Operative Complications, Wound Infection, Hip Deformity, Urinary Tract Infection, Dislocation, Pneumonia

Abstract

After total hip replacement many complications occur postoperatively. One of the serious complications is the surgical wound site infection that can convert into peri-prosthetic joint infection. Objective: To determine the rate of postoperative infection in patients with total hip replacement done in Ayub Teaching Hospital, Abbottabad. Methods: This retrospective cross-sectional study investigated 32 patients underwent total hip replacement in the Orthopedic Department of Ayub Teaching Hospital, Abbottabad from January 2020 to April 2024. All the adult patients underwent unilateral total hip replacement were enrolled. Patient’s demographic details, indication for surgery, co-morbidities, hip deformity, and post-operative complications were recorded. SPSS version 26.0 was used for data analysis. Results: The overall mean age and length of hospital stay was 54 ± 15.9 years and 14 ± 12.8 days. The incidence of post-operative infection was 34.4% (n=11). Wound infection was the most prevalent post-operative infection/complications found in 6 (18.8%) followed by urinary tract infection 3 (9.4%), dislocation 1 (3.1%), and pneumonia 1 (3.1%). According to univariate analysis, American system of anesthesiologist (ASA) grades, hip deformity, and blood transfusion were significantly associated with post-operative infection. Conclusion: It was concluded that several pre-operative risk factors considerably affect the probability of post-operative wound infection following total hip arthroplasty; hence, early diagnosis, management, and treatment are necessary to decrease morbidity and death.

References

Lopez DJ, Leach I, Moore E, Norrish AR. Management of the infected total hip arthroplasty. Indian Journal of Orthopaedics. 2017 Aug; 51: 397-404. doi: 10.4103/ortho.IJOrtho_307_16.

Bischoff P, Kramer TS, Schröder C, Behnke M, Schwab F, Geffers C et al. Age as a risk factor for surgical site infections: German surveillance data on total hip replacement and total knee replacement procedures 2009 to 2018. Eurosurveillance. 2023 Mar; 28(9): 2200535. doi: 10.2807/1560-7917.ES.2023.28.9.2200535.

León SA, Mei XY, Kuzyk PR. The infected total hip arthroplasty. Evidence‐Based Orthopedics. 2021 Aug: 191-7. doi: 10.1002/9781119413936.ch31.

Zahar A and Gehrke TA. One-stage revision for infected total hip arthroplasty. Orthopedic Clinics. 2016 Jan; 47(1): 11-8. doi: 10.1016/j.ocl.2015.08.004.

Finkelstein R, Eluk O, Mashiach T, Levin D, Peskin B, Nirenberg G et al. Reducing surgical site infections following total hip and knee arthroplasty: an Israeli experience. Musculoskeletal Surgery. 2017 Dec; 101: 219-25. doi: 10.1007/s12306-017-0471-2.

Li T, Zhang H, Chan PK, Fung WC, Fu H, Chiu KY. Risk factors associated with surgical site infections following joint replacement surgery: a narrative review. Arthroplasty. 2022 May; 4(1): 11. doi: 10.1186/s42836-022-00113-y.

Albanese J, Feltri P, Boffa A, Werner BC, Traina F, Filardo G. Infection risk increases after total hip arthroplasty within 3 months following intra-articular corticosteroid injection. A meta-analysis on knee and hip arthroplasty. The Journal of Arthroplasty. 2023 Jun; 38(6): 1184-93. doi: 10.1016/j.arth.2022.12.038.

Sambandam S, Serbin P, Senthil T, Varatharaj S, Sakthivelnathan V, Ramanan SP et al. Patient characteristics, length of stay, cost of care, and complications in super-obese patients undergoing total hip arthroplasty: A national database study. Clinics in Orthopedic Surgery. 2023 Jun; 15(3): 380. doi: 10.4055/cios22180.

Shahbazi P, Jalilvand AH, Ghaseminejad-Raeini A, Ghaderi A, Sheikhvatan M, Fallah Y et al. Risk factors for dislocation following total hip arthroplasty in developmental dysplasia of the hip: a systematic review and meta-analysis. International Orthopaedics. 2023 Dec; 47(12): 3063-75. doi: 10.1007/s00264-023-05949-w.

Fessy MH, Putman S, Viste A, Isida R, Ramdane N, Ferreira A et al. What are the risk factors for dislocation in primary total hip arthroplasty? A multicenter case-control study of 128 unstable and 438 stable hips. Orthopaedics & Traumatology: Surgery & Research. 2017 Sep; 103(5): 663-8. doi: 10.1016/j.otsr.2017.05.014.

Durrani MY, Saeed J, Umer M, Hashmi P. Functional outcomes and complications of total hip arthroplasty with dual mobility cup: an audit. JPMA. The Journal of the Pakistan Medical Association. 2021 Aug; 71(8 (Suppl 5): S87.

Mortazavi SM, Ghadimi E, Ardakani MV, Razzaghof M, Ghasemi MA, Nili A et al. Risk factors of dislocation after total hip arthroplasty in patients with developmental dysplasia of the hip. International Orthopaedics. 2022 Apr: 1-1. doi: 10.1007/s00264-021-05294-w.

León SA, Mei XY, Kuzyk PR. The infected total hip arthroplasty. Evidence‐Based Orthopedics. 2021 Aug: 191-7. doi: 10.1002/9781119413936.ch31.

Ren X, Ling L, Qi L, Liu Z, Zhang W, Yang Z et al. Patients' risk factors for periprosthetic joint infection in primary total hip arthroplasty: a meta-analysis of 40 studies. BioMed Central Musculoskeletal Disorders. 2021 Dec; 22: 1-7. doi: 10.1186/s12891-021-04647-1.

Eka A and Chen AF. Patient-related medical risk factors for periprosthetic joint infection of the hip and knee. Annals of Translational Medicine. 2015 Sep; 3(16): 233. doi: 10.3978/j.issn.2305-5839.2015.09.26.

Papalia R, Vespasiani-Gentilucci U, Longo UG, Esposito C, Zampogna B, Incalzi RA et al. Advances in management of periprosthetic joint infections: an historical prospective study. European Review for Medical & Pharmacological Sciences. 2019 Apr; 23(2): 129-138. doi: 10.26355/eurrev_201904_17482.

Sattar F, Sattar Z, Zaman M, Akbar S. Frequency of post-operative surgical site infections in a Tertiary care hospital in Abbottabad, Pakistan. Cureus. 2019 Mar; 11(3): e4243. doi: 10.7759/cureus.4243.

Assi C, Mansour J, Caton J, Samaha C, Yammine K, Yammine K. Total hip arthroplasty evolution of the use of dual mobility cups in Lebanon. Journal Medical Libanais. 2018 Oct; 66: 233. doi: 10.12816/0053375.

Stucinskas J, Kalvaitis T, Smailys A, Robertsson O, Tarasevicius S. Comparison of dual mobility cup and other surgical construts used for three hundred and sixty two first time hip revisions due to recurrent dislocations: five year results from Lithuanian arthroplasty register. International Orthopaedics. 2018 May; 42: 1015-20. doi: 10.1007/s00264-017-3702-0.

Jobory A, Kärrholm J, Overgaard S, Pedersen AB, Hallan G, Gjertsen JE et al. Reduced revision risk for dual-mobility cup in total hip replacement due to hip fracture: a matched-pair analysis of 9,040 cases from the Nordic Arthroplasty Register Association (NARA). Journal of Bone and Joint Surgery. 2019 Jul; 101(14): 1278-85. doi: 10.2106/JBJS.18.00614.