Unipolar Hemiarthroplasty, Bipolar Hemiarthroplasty, or Total Hip Arthroplasty for Hip Fracture in Older Individuals.

BACKGROUND: Practice patterns regarding the use of unipolar hemiarthroplasty, bipolar hemiarthroplasty, and total hip arthroplasty (THA) for femoral neck fractures in older patients vary widely. This is due in part to limited data stipulating the specific circumstances under which each form of arthroplasty provides the most predictable outcome. The purpose of this study was to investigate the patient characteristics for which unipolar hemiarthroplasty, bipolar hemiarthroplasty, or THA might be preferable due to a lower risk of all-cause revision. METHODS: A U.S. health-care system's hip fracture registry was used to identify patients ≥60 years old who underwent unipolar hemiarthroplasty, bipolar hemiarthroplasty, or THA for hip fracture from 2009 through 2021. Unipolar and bipolar hemiarthroplasty were compared with THA within patient subgroups defined by age (60 to 79 versus ≥80 years) and American Society of Anesthesiologists (ASA) classification (I or II versus III); patients with an ASA classification of IV or higher were excluded. Multivariable Cox proportional hazard regression analysis was used to evaluate all-cause revision risk while adjusting for confounders, with mortality considered as a competing risk. RESULTS: There were 14,277 patients in the final sample (median age, 82 years; 70% female; 80% White; 69% with an ASA classification of III; median follow-up, 2.7 years), and the procedures included 7,587 unipolar hemiarthroplasties, 5,479 bipolar hemiarthroplasties, and 1,211 THAs. In the multivariable analysis of all patients, both unipolar (hazard ratio [HR] = 2.15, 95% confidence interval [CI] = 1.48 to 3.12; p < 0.001) and bipolar (HR = 1.92, 95% CI = 1.31 to 2.80; p < 0.001) hemiarthroplasty had higher revision risks than THA. In the age-stratified multivariable analysis of patients aged 60 to 79 years, both unipolar (HR = 2.17, 95% CI = 1.42 to 3.34; p = 0.004) and bipolar (HR = 1.69, 95% CI = 1.08 to 2.65; p = 0.022) hemiarthroplasty also had higher revision risks than THA. In the ASA-stratified multivariable analysis, patients with an ASA classification of I or II had a higher revision risk after either unipolar (HR = 3.52, 95% CI = 1.87 to 6.64; p < 0.001) or bipolar (HR = 2.31, 95% CI = 1.19 to 4.49; p = 0.013) hemiarthroplasty than after THA. No difference in revision risk between either of the hemiarthroplasties and THA was observed among patients with an age of ≥80 years or those with an ASA classification of III. CONCLUSIONS: In this study of hip fractures in older patients, THA was associated with a lower risk of all-cause revision compared with unipolar and bipolar hemiarthroplasty among patients who were 60 to 79 years old and those who had an ASA classification of I or II. LEVEL OF EVIDENCE: Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.

Supine Knee Positioning Does Not Interfere with Mobile-Bearing Unicompartmental Knee Arthroplasty Performance.

The Food and Drug Administration has only approved mobile-bearing unicompartmental knee arthroplasty (MB-UKA) to be performed with a hanging leg holder. The purpose of this study is to evaluate the impact of a supine knee position on MB-UKA performance.In total, 16 cadavers were randomized so that either the right or left knee was placed in the flexed or supine positions. One board-certified orthopaedic surgeon and three adult reconstruction fellows that attended the required Oxford partial knee instructional course performed four operations in each position. The primary outcome was final knee balance. Secondary outcomes included procedure duration, timing of individual surgical steps, implant sizes, range of motion, implant alignment, and fracture. A Students t-test was used to examine differences between positions with significance set at p < 0.05. Secondary analyses using two one-sided tests were conducted to explore equivalence between the two positions.There was no significant difference in mean final balance between supine (1.7 mm ± standard deviation [SD] = 1.5 mm) and flexed (1.3 ± 1.3 mm) positions (p = 0.390). There were also no significant differences between positions for procedure time (p = 0.497), tibia coronal alignment (p = 0.614), tibial slope (p = 0.194), femoral component sagittal alignment (p = 0.091), and fractures (n = 0). Exploratory equivalence analyses indicated that the positions were equivalent for final balance (p = 0.002).MB-UKA performed in the supine position is not significantly different from the flexed position in terms of ligament balance, overall procedure time, and radiographic appearance. These initial safety data warrant further clinical investigations and support the expansion of the surgical technique to include performing MB-UKAs in the supine position.

Segmental Acetabular Defects Managed by Augments in Conjunction with CT During Robotic Total Hip Arthroplasty: A Report of 2 Cases.

CASES: We present 2 robotic-assisted hip arthroplasty cases with significant segmental acetabular defects that could compromise cup fixation. We outline an algorithmic planning approach on a computed tomography (CT)-based platform to address these defects by predicting augmentation needs, when component adjustments alone are inadequate, and describe the novel combination of augments in conjunction with robotic-assisted hip arthroplasty. CONCLUSION: CT-based robotic-assisted hip arthroplasty is a powerful tool to assess and address acetabular deficiencies. Rudimentary augment planning extracts additional value out of the preoperative CT. However, there remains room for intelligent assessment of hip centers and for deliberate augment planning and execution.

Notching of the Neck After Acetabular Constraint Necessitating Femoral Component Revision.

A 75-year-old woman who had previously undergone a left revision total hip arthroplasty with the use of a constrained acetabular liner presented with recurrent dislocation of the hip. Intraoperatively, there was metallic staining of the hip capsule and significant notching of the femoral neck, consistent with impingement of the intact locking ring, necessitating stem revision. Constrained acetabular liners have high failure rates due to intraprosthetic impingement, but to our knowledge, failure due to notching of the femoral component and metallosis from repeated impingement has not been described. Surgeons should be aware of this potential mode of failure.

Trends in topics presented as posters at the Scoliosis Research Society (SRS) annual meetings for the last 7 years: implications of an SRS annual meeting abstract registry (Part II).

PURPOSE: Analyzing and comparing past Scoliosis Research Society (SRS) poster and podium presentations would allow members to see trends in areas of interest and help authors guide future research efforts. METHODS: Abstract books from 2011 to 2017 were retrieved and titles were extracted. From each title and abstract body, keywords were identified and collected. Keywords were categorized into several groups: subjects of study, topics not related to treatment, conservative treatment, surgery, treatment result, complications, revision, long-term follow-up, cost, and questionnaire. Each category was subcategorized based on specific topics. Assignments of keywords were manually checked against their abstracts. The frequency of each keyword was ranked to represent areas of interest and trended according to year. The results were compared to trends in podium presentations. RESULTS: The most popular keywords in each group were similar to those of the podium presentations. There has been an increasing trend for: Early Onset Scoliosis, Radiographic Diagnosis, and Sagittal Alignment. There has been a decreasing trend for: Neuromuscular, X-ray, Posterior Surgery, Osteotomy, Pedicle Screws, Mental Failure/Misplaced Screw, Revision, and Hospital Stay. The distribution of topics of the poster presentation was not significantly different from those of podium presentation, but podium has more long-term follow-up studies. CONCLUSION: We report trends in SRS poster presentations. We found no significant difference between the topics of poster and those of podium presentations. We hope this data could help members better prepare for future meetings.

Analysis of Scoliosis Research Society (SRS) Podium Presentations for the Last Seven Years: Implications of an SRS Annual Meeting Abstract Registry.

STUDY DESIGN: Retrospective review of abstracts of SRS podium presentations from 2011 to 2017. OBJECTIVE: The objective of this study was to demonstrate trends in topics of SRS podium presentations and to create an abstract registry for future deformity research. SUMMARY OF BACKGROUND DATA: Podium presentations at the SRS annual meetings are considered excellent for their quality research in current areas of interest. Knowing the trends of these studies would help surgeons understand current interests in spinal deformity. METHODS: Abstract books from 2011 to 2017 were retrieved and titles were extracted. From each title and abstract body, keywords were identified and collected. Keywords were categorized into several groups: subjects of study, topics not related to treatment, conservative treatment, surgery, treatment result, complications, revision, long-term follow-up, cost, and questionnaire. The frequency of each keyword was ranked to represent areas of interest, and trended according to year. RESULTS: The most popular key words in each group were AIS, prognostic factor, posterior surgery, sagittal alignment, and nerve and cord safety. There has been an increasing trend for AIS, EOS, NM, ASD, tumors, etiology, pathology, prognostic factors, radiographic diagnoses, radiographic parameters, and questionnaire/database studies. There has been a decreasing trend for conservative treatment, postoperative care, growing rod, pedicle screws, hooks, bleeding, and radiation safety. CONCLUSION: We report the trend of SRS podium presentation. We hope that these data will be of interest to our members as a representation of where interests have been for the SRS, and these data can be the foundation of an SRS AM abstract registry for spinal deformity research.

Debridement, antibiotic pearls, and retention of the implant (DAPRI): A modified technique for implant retention in total knee arthroplasty PJI treatment.

We describe a modified surgical technique developed to enhance the classical irrigation and debridement procedure to improve the possibilities of retaining an infected total knee arthroplasty. This technique, debridement antibiotic pearls and retention of the implant (DAPRI), aims to remove the intra-articular biofilm allowing a higher and prolonged local antibiotic concentration using calcium sulfate beads. The combination of three different surgical techniques (methylene blue staining, argon beam electrical stimulation, and chlorhexidine gluconate brushing) might enhance the identification, disruption, and finally removal of the bacterial biofilm, which is the main responsible of antibiotics and antibodies resistance. The DAPRI technique might represent a safe and more conservative treatment for acute and early hematogenous periprosthetic joint infection.

Acute Paravertebral Compartment Syndrome: Follow-up and Literature Review.

OBJECTIVE: To report on a patient with acute paravertebral and posterior thigh compartment syndrome after vigorous exercise. BACKGROUND: Paravertebral compartment syndrome (PCS) is a rare clinical entity, typically occurring in male athletes after heavy exertion and weightlifting. CASE: A 25-year-old man presented with back pain and hematuria hours after back-specific weightlifting. Clinical examination, laboratory markers, MRI, and elevated intracompartmental pressure measurements supported the diagnosis of bilateral paravertebral and posterior thigh compartment syndrome. The patient underwent paravertebral decompression via the Wiltse approach with immediate postoperative relief. He is doing well at 1 year, with recovery of lumbar extension strength, although MRI demonstrates moderate fatty replacement of paravertebral musculature. CONCLUSIONS: Although rare, early recognition of PCS and timely decompression can limit myonecrosis. Paravertebral compartment syndrome should be considered in the differential for athletic individuals with acute onset back pain. STUDY DESIGN: A case report and review of literature.

Utility of Supine Lateral Radiographs for Assessment of Lumbar Segmental Instability in Degenerative Lumbar Spondylolisthesis.

STUDY DESIGN: Retrospective chart review OBJECTIVE.: To determine whether supine lateral radiographs increase the amount of segmental instability visualized in single-level lumbar degenerative spondylolisthesis, when compared to traditional lateral flexion-extension radiographs. We hypothesized that supine radiographs increase the amount of segmental instability seen in single-level lumbar spondylolisthesis when compared to flexion-extension. SUMMARY OF BACKGROUND DATA: Accurate evaluation of segmental instability is critical to the management of lumbar spondylolisthesis. Standing flexion-extension lateral radiographs are routinely obtained, as it is believed to precipitate the forward-backward motion of the segment; however, recent studies with magnetic resonance imaging and computed tomography have shown that the relaxed supine position can facilitate the reduction of the anterolisthesed segment. Here, we show that inclusion of supine lateral radiographs increases the amount of segmental instability seen in single-level lumbar spondylolisthesis when compared to traditional lateral radiographs. METHODS: Supine lateral radiographs were added to the routine evaluation (standing neutral/flexion/extension lateral radiographs) of symptomatic degenerative spondylolisthesis at our institution. In this retrospective study, 59 patients were included. The amount of listhesis was measured and compared on each radiograph: standing neutral lateral ("neutral"), standing flexion lateral ("flexion"), standing extension lateral ("extension"), and supine lateral ("supine"). RESULTS: A total of 59 patients (51 women, 8 men), with a mean age of 63.0 years (±9.85 yr) were included. The mean mobility seen with flexion-extension was 5.53 ±â€Š4.11. The mean mobility seen with flexion-supine was 7.83% ±â€Š4.67%. This difference was significant in paired t test (P = 0.00133), and independent of age and body mass index. Maximal mobility was seen between flexion and supine radiographs in 37 patients, between neutral and supine radiographs in 11 cases, and between traditional flexion-extension studies in 11 cases. CONCLUSION: Supine radiograph demonstrates more reduction in anterolisthesis than the extension radiograph. Incorporation of a supine lateral radiograph in place of extension radiograph can improve our understanding of segmental mobility when evaluating degenerative spondylolisthesis. LEVEL OF EVIDENCE: 3.

Primary Total Knee Arthroplasty for Distal Femur Fractures: A Systematic Review of Indications, Implants, Techniques, and Results.

Distal femur fractures (DFFs) in elderly patients historically were difficult to treat because of osteoporotic bone, comminution, and intra-articular involvement. Current surgical treatment options, including intramedullary nailing, internal fixation, and external fixation, are complicated by prolonged immobility, malunion, and nonunion. Furthermore, fixation increases the complexity of subsequent arthroplasty. Primary total knee arthroplasty (TKA) is a rarely used treatment for acute DFF but may be of benefit in select patients. For a systematic review of the reported indications, techniques, implants, outcomes, and complications of TKA for DFF, we searched the major databases Medline, EMBASE (Excerpta Medica dataBASE), and the Cochrane Library. Few studies of this technique have been reported, and the majority of published studies have been level III and level IV, with heterogeneous results and outcomes. Many of the patients in these studies achieved early weight-bearing with primary TKA. Complication rates varied and may be higher for older patients with more comorbidities, but whether these rates are higher than those of patients treated with internal fixation is unclear. Modular constrained implants may be appropriate for comminuted intra-articular fractures, whereas extra-articular fractures may be sufficiently managed with unconstrained implants supplemented with fracture fixation.

Trends in Attendance at Scoliosis Research Society Annual Meetings (SRS AM) and International Meeting on Advanced Spine Techniques (IMAST): Location, Location, Location.

STUDY DESIGN: Descriptive, respective. OBJECTIVE: Although overall membership in Scoliosis Research Society (SRS) has grown over the years, we were curious to see the effects of changing event venue location and timing on conference attendance. SUMMARY OF BACKGROUND DATA: Every year, the SRS hosts two major meetings: the Annual Meeting (SRS AM) in the autumn, and the International Meeting on Advanced Spine Techniques (IMAST) in the summer. Sites have alternated from within and outside North America. Often, these meetings have also overlapped with several holidays in certain countries. METHODS: This was an observational study of attendance from past SRS AM and IMAST meetings. Fourteen years of AM and 8 years of IMAST data were made available from the SRS. Participation based on delegate type and countries were tallied. Details from the 10 most represented nations and host nations per year were also tallied, and their national holidays were reviewed for overlaps with the AM. RESULTS: Membership in AM and IMAST increased from 820 in 2003 to 1,323 in 2016. Attendance at the AM has increased, whereas attendance at IMAST has declined, even after adjusting for membership size. Trends in participation were highly influenced by location. Participation by attendees from the host continent, and especially the host country, is generally high. The negative impact of distant meetings is profoundly seen with North Americans, whereas the positive impact of a nearby meeting was mostly clearly demonstrated by South Americans. Although SRS AM overlapped with holidays in China, Japan, or Korea nearly 50% of the time, this did not influence participation by delegates from these countries. CONCLUSION: Participation in the AM is highly influenced by location. Although North Americans represented the largest constituency, their presence was not needed to drive total attendance and was not sufficient to turn around the downturn in IMAST attendance. Choice of location can encourage the participation of delegates from the host and neighboring nations; through strategic selection of location, a balance can be reached between participation and global representation.

Nonsurgical Treatment of Aseptic Periprosthetic Gout Flare of the Knee: A Report of 2 Cases.

CASE: Gout is a rarely reported cause of a painful knee following total knee arthroplasty, but it can mimic infection in its symptomatology and workup. Two individuals who had previously undergone a knee replacement and had a history of gout had symptoms of infection. These patients presented with knee warmth and effusion, and they had elevated inflammatory markers and synovial cell counts. In both cases, there was a good response to medication, and surgery was avoided. CONCLUSION: Although simultaneous infection can occur, aseptic periprosthetic gout should be considered in individuals with a known history of gout, in those with a good response to anti-gout medication, and when there is an otherwise negative workup for infection.

In vitro comparison of endplate preparation between four mini-open interbody fusion approaches.

PURPOSE: Discectomy and endplate preparation are important steps in interbody fusion for ensuring sufficient arthrodesis. While modern less-invasive approaches for lumbar interbody fusion have gained in popularity, concerns exist regarding their ability to allow for adequate disc space and endplate preparation. Thus, the purpose of this study was to quantitatively and qualitatively evaluate and compare disc space and endplate preparation achieved with four less-invasive approaches for lumbar interbody fusion in cadaveric spines. METHODS: A total of 24 disc spaces (48 endplates) from L2 to L5 were prepared in eight cadaveric torsos using mini-open anterior lumbar interbody fusion (mini-ALIF), minimally invasive posterior lumbar interbody fusion (MAS PLIF), minimally invasive transforaminal lumbar interbody fusion (MAS TLIF) or minimally invasive lateral, transpsoas interbody fusion (XLIF) on two specimens each, for a total of six levels and 12 endplates prepared per procedure type. Following complete discectomy and endplate preparation, spines were excised and split axially at the interbody disc spaces. Endplates were digitally photographed and evaluated using image analysis software. Area of endplate preparation was measured and qualitative evaluation was also performed to grade the quality of preparation. RESULTS: The XLIF approach resulted in the greatest relative area of endplate preparation (58.3 %) while mini-ALIF resulted in the lowest at 35.0 %. Overall, there were no differences in percentage of preparation between cranial and caudal endplates, though this was significantly different in the XLIF group (65 vs 52 %, respectively). ALL damage was observed in 3 MAS TLIF levels. Percentage of endplate that was deemed to have complete disc removal was highest in XLIF group with 90 % compared to 65 % in MAS TLIF group, 43 % in MAS PLIF, and 40 % in mini-ALIF group. Endplate damage area was highest in the MAS TLIF group at 48 % and lowest in XLIF group at 4 %. CONCLUSIONS: These results demonstrate that adequate endplate preparation for interbody fusion can be achieved utilizing various minimally invasive approach techniques (mini-ALIF, MAS TLIF, MAS PLIF, XLIF), however, XLIF appears to provide a greater area of and more complete endplate preparation.

Atypical Vancouver Type-C Periprosthetic Fracture Complicated by Nonunion: A Case Report.

CASE: In recent years, atypical femoral fractures (AFFs) associated with bisphosphonate use have increasingly been reported, but current definitions limit their diagnosis to native femora. Atypical periprosthetic fractures are rare. We present a case of a Vancouver type-C periprosthetic fracture that was recognized as an AFF following nonunion. CONCLUSION: Bisphosphonate-associated AFFs can present as periprosthetic fractures. Delayed recognition of the role of bisphosphonates in a periprosthetic fracture may lead to a worse outcome, including a delay in diagnosis, delayed union, and failure of fixation.

Absence of femoral cortical thickening in long-term bisphosphonate users: implications for atypical femur fractures.

The radiographs of patients on long term bisphosphonates with atypical femur fractures demonstrate markedly thick cortices at the site of the fracture. We conducted a prospective clinical study to determine if cortical thickening is increased in long term bisphosphonate users. We recruited 43 patients who had taken bisphosphonates for more than 5 years. A group of 45 healthy volunteers and 12 patients recently diagnosed with osteoporosis served as controls. We measured the cortical thickening as the ratio of femoral cortical thickness to diameter of the femur, and looked for cortical beaking. No difference in the cortical thickness ratio was observed between long term bisphosphonate users and osteoporotic controls (0.53 vs. 0.54, p=0.659). No cases of cortical beaking were seen and no increase in thigh pain was observed. The power of the study was 95% to detect a 10% difference in cortical thickness ratio. We conclude that long term bisphosphonate use does not produce a generalized increase in subtrochanteric femoral cortical thickening in the majority of patients.

Outcomes of nails versus plates for humeral shaft fractures: a Medicare cohort study.

OBJECTIVES: This study was performed to determine (1) the incidence of humeral shaft fractures within the Medicare noncancer population, (2) the trends in utilization of humeral shaft fixation techniques by plate-and-screw devices and intramedullary nails, (3) differences in procedure times, and (4) the outcomes of individuals as measured by rate of secondary operations and 1-year mortality. DESIGN/SETTING: Retrospective comparative cohort analysis. A cancer-free Medicare part B claims sample derived from a 5% sample from the years 1993 to 2007 was analyzed. PATIENTS/INTERVENTION: Our cohorts were generated by diagnostic and procedural codes for humeral shaft fractures. MAIN OUTCOME MEASUREMENT: The incidence of humeral shaft fracture and trend in operative fixation were evaluated for all years of data. Surgical times were assessed by anesthesia Current Procedural Terminology codes. Outcomes and complications were assessed by Current Procedural Terminology codes. The proportion of individuals experiencing complications and 1-year mortality were compared by proportion hazards. RESULTS: We identified 1385 claims for humeral shaft fractures over 15 years, with an adjusted rate of between 12.0 and 23.4 fractures per 100,000 beneficiaries. We identified 511 individuals who received surgical treatment for humeral shaft fractures, 451 of whom had complete 1-year follow-up data. Nail fixation was more prevalent than plate fixation most years and had shorter anesthesia time by 27.1 minutes (P < 0.0001). There were no significant differences in the complication rates between the 2 groups as measured by incidence of secondary operations and 1-year mortality. CONCLUSIONS: Intramedullary nails are used for the majority of operative humeral shaft fractures among Medicare beneficiaries. Nailing has a shorter mean operative time. The 2 surgical techniques had no significant differences in terms of risk of secondary procedures and 1-year mortality. LEVEL OF EVIDENCE: : Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Convergence of outcomes for hip fracture fixation by nails and plates.

BACKGROUND: Recent popularity of intramedullary nails over sliding hip screws for treatment of intertrochanteric fractures is concerning given the absence of evidence for clinical superiority for nailing yet the presence of reimbursement differences. QUESTIONS/PURPOSES: We describe the change in outcomes of both procedures across a 15-year span and address the role of reimbursements in the setting of shifting patterns in use. METHODS: A 5% sample of Medicare enrollees from 1993 to 2007 was used. Cohorts were generated along diagnostic and procedure codes. Trends in device use by hospital type, surgical times, and rate of revision surgeries were compared. Historic reimbursements were examined. RESULTS: Since 2005, intramedullary nail fixation has become the more common treatment in government, nonprofit, and for-profit hospitals. Before 1999, intramedullary nailing required 36 minutes longer to perform than plate-and-screw fixation on average, and had higher revision surgery rates (hazard ratio, 2.48; CI, 1.37-4.48) and 1-year mortality (hazard ratio, 1.42; CI, 1.01-1.99). These differences were not significant since 2000. Reimbursement differences have been consistently in favor of intramedullary nails. CONCLUSION: Intramedullary nailing of intertrochanteric fractures has become as safe and efficient as the sliding hip screws, but has been more popular since 2006. Reimbursements were favorable for intramedullary nails in times of low and high use. These results argue against the reimbursement difference as the sole driving force for use of intramedullary nails. LEVEL OF EVIDENCE: Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Compliance with Surgical Care Improvement Project measures and hospital-associated infections following hip arthroplasty.

BACKGROUND: Hospital compliance with the Surgical Care Improvement Project (SCIP) measures has increased recently for patients undergoing hip arthroplasty. However, reductions in postoperative infections were less than expected, and concern remains about complications associated with prophylaxis against venous thromboembolism (VTE). We sought to examine the association between hospital adherence to SCIP measures and postoperative infections. METHODS: We conducted an observational study of 17,714 patients who underwent hip replacement in 2008 at 128 New York state hospitals. These hospitals were divided into less compliant and highly compliant groups, on the basis of their levels of compliance compared with the median value of compliance with SCIP measures. From the New York State Department of Health annual report, we collected the confirmed postoperative infections at the facility level. From the Healthcare Cost and Utilization Project state inpatient database, we identified incidences of postoperative infections at the patient level, using International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes. RESULTS: During 2008, mean hospital compliance increased from 93.5% to 96.0% for the infection prevention measure and from 91.4% to 97.5% for the VTE prevention measure. Higher adherence to infection prevention measures was not associated with a significant reduction in infection (p ≥ 0.09 for all). Hospitals that were at least 97% compliant with the SCIP VTE-2 measure (patients receiving VTE prophylaxis around the time of surgery) reported significantly higher infection rates compared with less compliant hospitals (1.60% versus 0.93%; p < 0.001). Similarly, patients from highly compliant hospitals (for the VTE-2 measure) were at significant risk of postoperative infection (adjusted odds ratio, 1.50; 95% confidence interval, 1.07 to 2.12; p = 0.02). CONCLUSIONS: Targeting complete compliance with SCIP infection prevention measures was not associated with additional reductions in infection outcomes following hip replacement. Furthermore, significant risk of postoperative infections may result from increased perioperative use of VTE prophylactics.