What’s New in Hip Replacement 2020

Every month, JBJS reviews the most pertinent and impactful studies published in the orthopaedic literature during the previous year in 13 subspecialties. Click here for a collection of all OrthoBuzz specialty-update summaries.

This month, Mengnai Li, MD, PhD, co-author of the September 16, 2020 “What’s New in Hip Replacement,” selected the five most clinically compelling findings from among the 95 noteworthy studies summarized in the article.

Medical Comorbidities and Outcomes of Joint Arthroplasty
–Among 543 malnourished joint arthroplasty patients (with albumin levels <3.4 g/L), an intervention encouraging  a high-protein, anti-inflammatory diet shortened the length of hospital stay and lowered readmissions, relative to malnourished arthroplasty patients who did not receive the intervention.¹

Surgical Factors and Outcomes of Total Hip Arthroplasty (THA)
–A multicenter, prospective study used propensity-score matching to compare THA performed with a direct anterior approach with THA performed with a posterolateral approach. Researchers found no patient-reported outcome differences at 1.5 months postoperatively or at ≥1 year up to 5 years.²

Periprosthetic Joint Infection (PJI)
–A Musculoskeletal Infection Society workgroup published a recommendation for a 4-tier tool for reporting outcomes after surgical treatment of PJI. Proposed outcomes include infection control with no antibiotic treatment, infection control with suppressive antibiotic therapy, need for reoperation and/or revision and/or spacer retention, and death.

–A meta-analysis found only low-quality retrospective evidence supporting the practice of routinely applying intrawound vancomycin to reduce the rates of PJI. Authors called for a prospective randomized trial before adoption of this practice.³

Postoperative Urinary Retention
–A randomized controlled trial found that preoperative and perioperative administration of tamsulosin did not reduce the incidence of postoperative urinary retention after hip and knee arthroplasty. However, the study included a general male population rather than a higher-risk group.⁴

References

1. Schroer WC, LeMarr AR, Mills K, Childress AL, Morton DJ, Reedy ME. 2019 Chitranjan S. Ranawat Award: elective joint arthroplasty outcomes improve in malnourished patients with nutritional intervention: a prospective population analysis demonstrates a modifiable risk factor. Bone Joint J.2019 Jul;101-B(7_Supple_C):17-21.
2. Sauder N, Vestergaard V, Siddiqui S, Galea VP, Bragdon CR, Malchau H, Elsharkawy KA, Huddleston JI 3rd, Emerson RH. The AAHKS Clinical Research Award: no evidence for superior patient-reported outcome scores after total hip arthroplasty with the direct anterior approach at 1.5 months postoperatively, and through a 5-year follow-up. J Arthroplasty.2020 Feb 12.
3. Heckmann ND, Mayfield CK, Culvern CN, Oakes DA, Lieberman JR, Della Valle CJ. Systematic review and meta-analysis of intrawound vancomycin in total hip and total knee arthroplasty: a call for a prospective randomized trial. J Arthroplasty.2019 Aug;34(8):1815-22. Epub 2019 Apr 1.
4. Schubert MF, Thomas JR, Gagnier JJ, McCarthy CM, Lee JJ, Urquhart AG, Pour AE. The AAHKS Clinical Research Award: prophylactic tamsulosin does not reduce the risk of urinary retention following lower extremity arthroplasty: a double-blinded randomized controlled trial. J Arthroplasty.2019 Jul;34(7S):S17-23. Epub 2019 Mar 20.