Impaired renal function is an independent risk factor for complications after surgery for femoral neck fracture.

BACKGROUND: The metabolic abnormalities that occur secondary to chronic kidney disease (CKD) increase the risk of femoral neck fractures compared to the general population. The purpose of this study is to determine whether impaired renal function is an independent risk factor for complications after surgery for femoral neck fracture. METHODS: The ACS-NSQIP database was reviewed for patients who underwent total hip arthroplasty, hemiarthroplasty and open reduction internal fixation (ORIF) for femoral neck fractures between 2007 and 2018. Patients were split into cohorts based on calculated estimated glomerular filtration rate. Demographic information, comorbidities, and 30-day complications were analysed with univariate and multivariate analyses using chi-square, Fischer's exact and analysis of variance testing. RESULTS: The total number of patients for the study was 163,717. Patients with CKD stage 4 and 5 had an increased rate of any complication (39.1 and 36.7% respectively) compared with higher eGFRs (p < 0.001). Similarly, 30-day mortality was increased at 6.0% and 6.7% for both stage 4 and 5 (p < 0.001). By multivariate regression, those with CKD Stage 4 and 5 were at increased risk for any complication compared to patients with a normal preoperative eGFR of 90-120 (p < 0.001). CONCLUSIONS: This study demonstrated that patients with CKD Stage 4 and 5 are at increased risks of all complications, including death, renal, pulmonary and thromboembolic disease. Therefore, these patients should be cared for from a multidisciplinary approach with close attention to postoperative medications and fall prevention to help mitigate the risk of complications in the immediate postoperative period.

Increased Risk of 90-Day Surgical-Site Infection and Hospital Readmission but Not Reoperation After Open Arthrotomy When Compared With Arthroscopy for Septic Ankle Arthritis.

PURPOSE: To compare the rates of reoperation and 90-day perioperative complications between open arthrotomy and arthroscopy for the treatment of septic ankle arthritis using a national all-payer claims database. METHODS: Patients with a diagnosis of septic ankle arthritis who underwent irrigation and debridement through arthroscopy or arthrotomy were identified in a national data set from 2015-2020 through an all-payer claims database. Demographic and comorbidity characteristics including age, sex, infectious etiologies, and Elixhauser comorbidities were obtained. The rate of reoperation, defined as a proxy for failure of initial intervention, was the primary outcome. Secondary outcomes including readmissions, surgical-site infections, amputations, wound complications, and 90-day medical complications were compared between the 2 cohorts. RESULTS: In total, 168 patients undergoing arthroscopy and 794 patients undergoing arthrotomy for septic ankle arthritis were identified. There were no significant differences in reoperation rates between patients who underwent open arthrotomy and those who underwent arthroscopy (P = .997). However, the rates of surgical-site infection (P = .014) and hospital readmission (P < .001) were significantly higher in the open arthrotomy cohort compared with the arthroscopy cohort. CONCLUSIONS: Although there was no significant difference in reoperation rates between arthroscopic and open irrigation and debridement for the treatment of septic ankle arthritis, this study showed significantly higher odds of surgical-site infection and hospital readmission in patients who underwent open arthrotomy when compared with arthroscopy. Case-specific patient and technical considerations should guide the surgical decision-making process to limit secondary complications because this study exemplifies similar reoperation rates between the 2 surgical modalities. LEVEL OF EVIDENCE: Level III, nonrandomized cohort analysis.

Preoperative estimated glomerular filtration rate is a marker for postoperative complications following aseptic revision total hip arthroplasty.

INTRODUCTION: Revision total hip arthroplasty (rTHA) is increasingly performed but may carry a high rate of complication. This aim of the study was to determine if a decreased eGFR increases risks of postoperative complications following rTHA. METHODS: A retrospective cohort study using the American College of Surgeons National Quality Improvement Program Database was conducted. Patients undergoing rTHA between 2007 and 2014 were identified and stratified by glomerular filtration rates (eGFR): eGFR > 125 mL/min, eGFR 90-125 mL/min, eGFR 60-90 mL/min, eGFR 30-60 mL/min, and eGFR < 30 mL/min. The incidence of postoperative adverse events within 30 days, including cardiac, pulmonary, renal, septic, thromboembolic, urinary tract, and wound complications, blood transfusion, death, length of stay > 7 days, and unplanned return to the operating room, was assessed. The complication rates following rTHA were assessed with univariate and multivariate analysis with a significance set at p < 0.05. RESULTS: In total, 8898 revision THA procedures were included for analysis. 28.4% of patients that underwent rTHA developed a complication following surgery. Following adjustment, an eGFR of less than 30 mL/min independently increased the odds of any complication (OR 1.447; 95% C.I. 1.010-2.074; p = 0.044), cardiac complications (OR 3.344; 95% C.I. 1.040-10.752; p = 0.043), blood transfusion (O.R. 1.623; 95% C.I. 1.122-2.352; p = 0.010), and extended length of stay (O.R. 2.392; 95% C.I. 1.526-3.759; p < 0.001) when compared to normal renal function. CONCLUSIONS: Diminished eGFR of less than 30 mL/min increased the odds of total complications, cardiac complications, blood transfusions, and extended length of stay compared to normal renal function.

Hematogenous infection of a total knee arthroplasty with Klebsiella pneumoniae in association with occult adenocarcinoma of the cecum.

Acute hematogenous septic arthritis caused by the genus Klebsiella is extremely rare. This case report describes a prosthetic joint infected with Klebsiella pneumoniae via acute hematogenous spread. This is the first reported case of K pneumoniae pyogenic arthritis with a coexisting occult colonic adenocarcinoma. The patient was treated successfully with open irrigation, debridement, polyethylene spacer exchange, and chronic suppressive antibiotics. The underlying colon cancer was recognized early, and the patient responded well to surgery and adjuvant chemotherapy. This case illustrates the importance of having a high index of suspicion for underlying pathologic processes when an unusual organism presents as the cause of septic arthritis.