A new study from the University of Arkansas for Medical Sciences (UAMS) in Little Rock has tackled the topic of whether surgeons should wait until modifiable risk factors improve so as to help prevent joint revision surgery.
New Study: Risk Factors for Revision Arthroplasty
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The retrospective review, “Modifiable Risk Factors Are Common in Early Revision Hip and Knee Arthroplasty,” was published in the December 2017 edition of The Journal of Arthroplasty.
The authors wrote, “A retrospective review of all revision total hip and knee arthroplasties performed at an academic, tertiary referral center within 2 years of primary surgery was conducted…”
C. Lowry Barnes, M.D., chair of the University of Arkansas for Medical Sciences (UAMS) College of Medicine’s Department of Orthopaedic Surgery, was a co-author on the study. Dr. Barnes told OTW, “We became interested in this topic because it seemed to us, as a tertiary referral center, that we were seeing many patients with infected total joints, dislocations, and extensor mechanism ruptures that we would not have performed total joint replacement with their modifiable risk factors. Our IRB [Institutional Review Board] approved review certainly confirmed this.”
The authors wrote, “A total of 128 revision arthroplasties were performed at our institution in one year. And 23 of 57 (40.4%) total hip revision and 31 of 71 (43.7%) total knee revision patients had at least 1 modifiable risk factor. Infected hip revision patients were more likely to have increased body mass index compared to noninfected patients. Infected knee revision patients were more likely to smoke, have poor dentition, and have >1 contraindication compared to noninfected patients.”
Dr. Barnes commented to OTW, “Our study most likely underestimates the number of patients whom we would have delayed until their risk factors were addressed. For instance, many of the patients did not have hemoglobin A1 C pre-op data available to us.”
“While we certainly don’t know the overall number of patients in our state who had primary joint replacement in the setting of significant modifiable risk factors, we are certain that we can impact early failure and complication rates by better preparing our patients for surgery.”
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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