Title: Letter to the Editor on “Total Hip Arthroplasty After Prior Acetabular Fracture: Infection Is a Real Concern”
Abstract: Recently, I read with great interest Rezaie et al.’s [[1]Rezaie A.A. Blevins K. Kuo F.-C. Manrique J. Restrepo C. Parvizi J. Total hip arthroplasty after prior acetabular fracture: infection is a real concern.J Arthroplasty. 2020; 35: 2619-2623Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar] retrospective study examining that the impact of prior open reduction and internal fixation (ORIF) of acetabular fractures on the rate of periprosthetic joint infection (PJI) after conversion total hip arthroplasty (THA). Authors demonstrated that conversion THA in patients with prior ORIF of acetabular fractures is associated with higher complication rate, in particular PJI, and less optimal outcome compared with patients undergoing primary THA. I really appreciate the work that has been done by the authors. However, there is an important issue that I would like to communicate with the authors. I think many readers are interested in the risk factors for PJI after THA. By a subgroup analysis, authors showed that cases with PJI had a significantly higher volume of blood loss, comparing with noninfected cases (1180 ± 1139 vs 431 ± 428, P = .002). However, the retention of hardware, use of augments in the acetabulum, or transfusion rate was not found to be statistically associated with PJI. Several other risk factors for PJI are known from previous studies. Kittle et al. showed that corticosteroid use for a chronic condition for patients who underwent total joint arthroplasty was found to be independently associated with PJI [[2]Kittle H. Ormseth A. Patetta M.J. Sood A. Gonzalez M.H. Chronic corticosteroid use as a risk factor for perioperative complications in patients undergoing total joint arthroplasty.J Am Acad Orthop Surg Glob Res Rev. 2020; 4: e2000001https://doi.org/10.5435/JAAOSGlobal-D-20-00001Crossref PubMed Scopus (8) Google Scholar]. Guo et al. also showed that high body mass index, long surgical time, large postoperative drainage volume, long hospitalization stay, history of surgery at incisions, previous use of immunosuppressants, preoperative hypoproteinemia, and superficial infection were independent risk factors for PJI after primary hip and knee arthroplasty [[3]Guo H. Xu C. Chen J. Risk factors for periprosthetic joint infection after primary artificial hip and knee joint replacements.J Infect Dev Ctries. 2020; 14: 565-571https://doi.org/10.3855/jidc.11013Crossref PubMed Scopus (4) Google Scholar]. Were these risk factors associated with PJI after conversion THA in patients with prior ORIF of acetabular fractures? I respectfully appreciate that Rezaie et al. provided me with this important study. However, this issue should be addressed because it is important to identify the risk factors for PJI after THA in patients with prior ORIF in order to mitigate the substantial social and economic burden. Download .pdf (.5 MB) Help with pdf files Conflict of Interest Statement for Shigemura Total Hip Arthroplasty After Prior Acetabular Fracture: Infection Is a Real ConcernThe Journal of ArthroplastyVol. 35Issue 9PreviewAcetabular fractures often require surgical intervention for fracture fixation and can result in premature osteoarthritis of the hip joint. This study hypothesized that total hip arthroplasty (THA) in patients with a prior acetabular fracture who had undergone open reduction and internal fixation (ORIF) is associated with a higher rate of subsequent periprosthetic joint infection (PJI). Full-Text PDF Response to Letter to the Editor on ”Total Hip Arthroplasty After Prior Acetabular Fracture: Infection Is a Real Concern”The Journal of ArthroplastyVol. 36Issue 2PreviewI read the letter with pleasure and evaluated all the parameters that the reader pointed out. As mentioned in our letter, there are some known risk factors for periprosthetic joint infection (PJI) such as high body mass index, long surgical time, large postoperative drainage volume, corticosteroid consumption, long hospitalization stay, history of surgery at the incision site, previous use of immunosuppressants, preoperative hypoproteinemia, and superficial infection. Full-Text PDF