Do retained pediatric implants impact later total hip arthroplasty?

Jessica Woodcock, A. Noelle Larson, Tad M. Mabry, Anthony A. Stans

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

BACKGROUND: It is debated whether all pediatric implants in the proximal femur should be removed in childhood. Hardware removal requires an additional surgical procedure and may put the child at risk for postoperative fracture. However, the impact of retained pediatric implants on future surgeries such as total hip arthroplasty (THA) is not well-understood. We undertook this case-control study to evaluate the effect of retained pediatric implants on surgical complexity and complications at the time of THA. This may offer insight as to whether pediatric proximal femoral implants should be removed in childhood. METHODS: Case-control study. Between 1990 and 2007, 15,601 primary THAs were performed at a tertiary referral center. Of those, 31 hips had pediatric hardware that had been implanted at a mean of 31 years before the time of THA. Perioperative course and complications were compared with an age-matched, sex-matched, and BMI-matched cohort of 31 patients with no retained implants. Mean follow-up after arthroplasty was 7 years. RESULTS: Operative time was significantly longer in the retained implant group compared with the control group (230 vs. 159 min; P<0.0001), as was the hospital stay (5.2 vs. 3.8 d; P=0.02). Four of the 14 patients with retained plates required a strut allograft at the time of primary THA. Revision femoral stems and bone grafting were more frequently required in the retained implant cohort. Estimated blood loss was also higher in the retained implant cohort (886 vs. 583 mL; P=0.031). Seven patients in the retained hardware group had a major complication, including intraoperative fracture (5), bleeding (1), and nerve injury (1), whereas no patients in the control group sustained major complications (P=0.017). CONCLUSIONS: Retained pediatric implants removed at the time of THA were associated with increased operative time, length of stay, and risk of intraoperative fracture. This data supports routine removal of proximal femoral implants in pediatric patients with a high likelihood of future THA. LEVEL OF EVIDENCE: III, case-control study.

Original languageEnglish (US)
Pages (from-to)339-344
Number of pages6
JournalJournal of Pediatric Orthopaedics
Volume33
Issue number3
DOIs
StatePublished - Apr 2013

Fingerprint

Arthroplasty
Hip
Pediatrics
Thigh
Case-Control Studies
Operative Time
Length of Stay
Tacrine
Control Groups
Bone Transplantation
Intraoperative Complications
Tertiary Care Centers
Femur
Allografts
Hemorrhage
Wounds and Injuries

Keywords

  • Implant
  • Pediatric
  • Retained hardware
  • Total hip arthroplasty

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Orthopedics and Sports Medicine

Cite this

Do retained pediatric implants impact later total hip arthroplasty? / Woodcock, Jessica; Larson, A. Noelle; Mabry, Tad M.; Stans, Anthony A.

In: Journal of Pediatric Orthopaedics, Vol. 33, No. 3, 04.2013, p. 339-344.

Research output: Contribution to journalArticle

Woodcock, Jessica ; Larson, A. Noelle ; Mabry, Tad M. ; Stans, Anthony A. / Do retained pediatric implants impact later total hip arthroplasty?. In: Journal of Pediatric Orthopaedics. 2013 ; Vol. 33, No. 3. pp. 339-344.
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abstract = "BACKGROUND: It is debated whether all pediatric implants in the proximal femur should be removed in childhood. Hardware removal requires an additional surgical procedure and may put the child at risk for postoperative fracture. However, the impact of retained pediatric implants on future surgeries such as total hip arthroplasty (THA) is not well-understood. We undertook this case-control study to evaluate the effect of retained pediatric implants on surgical complexity and complications at the time of THA. This may offer insight as to whether pediatric proximal femoral implants should be removed in childhood. METHODS: Case-control study. Between 1990 and 2007, 15,601 primary THAs were performed at a tertiary referral center. Of those, 31 hips had pediatric hardware that had been implanted at a mean of 31 years before the time of THA. Perioperative course and complications were compared with an age-matched, sex-matched, and BMI-matched cohort of 31 patients with no retained implants. Mean follow-up after arthroplasty was 7 years. RESULTS: Operative time was significantly longer in the retained implant group compared with the control group (230 vs. 159 min; P<0.0001), as was the hospital stay (5.2 vs. 3.8 d; P=0.02). Four of the 14 patients with retained plates required a strut allograft at the time of primary THA. Revision femoral stems and bone grafting were more frequently required in the retained implant cohort. Estimated blood loss was also higher in the retained implant cohort (886 vs. 583 mL; P=0.031). Seven patients in the retained hardware group had a major complication, including intraoperative fracture (5), bleeding (1), and nerve injury (1), whereas no patients in the control group sustained major complications (P=0.017). CONCLUSIONS: Retained pediatric implants removed at the time of THA were associated with increased operative time, length of stay, and risk of intraoperative fracture. This data supports routine removal of proximal femoral implants in pediatric patients with a high likelihood of future THA. LEVEL OF EVIDENCE: III, case-control study.",
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T1 - Do retained pediatric implants impact later total hip arthroplasty?

AU - Woodcock, Jessica

AU - Larson, A. Noelle

AU - Mabry, Tad M.

AU - Stans, Anthony A.

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N2 - BACKGROUND: It is debated whether all pediatric implants in the proximal femur should be removed in childhood. Hardware removal requires an additional surgical procedure and may put the child at risk for postoperative fracture. However, the impact of retained pediatric implants on future surgeries such as total hip arthroplasty (THA) is not well-understood. We undertook this case-control study to evaluate the effect of retained pediatric implants on surgical complexity and complications at the time of THA. This may offer insight as to whether pediatric proximal femoral implants should be removed in childhood. METHODS: Case-control study. Between 1990 and 2007, 15,601 primary THAs were performed at a tertiary referral center. Of those, 31 hips had pediatric hardware that had been implanted at a mean of 31 years before the time of THA. Perioperative course and complications were compared with an age-matched, sex-matched, and BMI-matched cohort of 31 patients with no retained implants. Mean follow-up after arthroplasty was 7 years. RESULTS: Operative time was significantly longer in the retained implant group compared with the control group (230 vs. 159 min; P<0.0001), as was the hospital stay (5.2 vs. 3.8 d; P=0.02). Four of the 14 patients with retained plates required a strut allograft at the time of primary THA. Revision femoral stems and bone grafting were more frequently required in the retained implant cohort. Estimated blood loss was also higher in the retained implant cohort (886 vs. 583 mL; P=0.031). Seven patients in the retained hardware group had a major complication, including intraoperative fracture (5), bleeding (1), and nerve injury (1), whereas no patients in the control group sustained major complications (P=0.017). CONCLUSIONS: Retained pediatric implants removed at the time of THA were associated with increased operative time, length of stay, and risk of intraoperative fracture. This data supports routine removal of proximal femoral implants in pediatric patients with a high likelihood of future THA. LEVEL OF EVIDENCE: III, case-control study.

AB - BACKGROUND: It is debated whether all pediatric implants in the proximal femur should be removed in childhood. Hardware removal requires an additional surgical procedure and may put the child at risk for postoperative fracture. However, the impact of retained pediatric implants on future surgeries such as total hip arthroplasty (THA) is not well-understood. We undertook this case-control study to evaluate the effect of retained pediatric implants on surgical complexity and complications at the time of THA. This may offer insight as to whether pediatric proximal femoral implants should be removed in childhood. METHODS: Case-control study. Between 1990 and 2007, 15,601 primary THAs were performed at a tertiary referral center. Of those, 31 hips had pediatric hardware that had been implanted at a mean of 31 years before the time of THA. Perioperative course and complications were compared with an age-matched, sex-matched, and BMI-matched cohort of 31 patients with no retained implants. Mean follow-up after arthroplasty was 7 years. RESULTS: Operative time was significantly longer in the retained implant group compared with the control group (230 vs. 159 min; P<0.0001), as was the hospital stay (5.2 vs. 3.8 d; P=0.02). Four of the 14 patients with retained plates required a strut allograft at the time of primary THA. Revision femoral stems and bone grafting were more frequently required in the retained implant cohort. Estimated blood loss was also higher in the retained implant cohort (886 vs. 583 mL; P=0.031). Seven patients in the retained hardware group had a major complication, including intraoperative fracture (5), bleeding (1), and nerve injury (1), whereas no patients in the control group sustained major complications (P=0.017). CONCLUSIONS: Retained pediatric implants removed at the time of THA were associated with increased operative time, length of stay, and risk of intraoperative fracture. This data supports routine removal of proximal femoral implants in pediatric patients with a high likelihood of future THA. LEVEL OF EVIDENCE: III, case-control study.

KW - Implant

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KW - Total hip arthroplasty

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