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Consensus on Reducing Risk in Total Joint Arthroplasty

Revision Surgery

Hickernell, Thomas R. MD; Cooper, H. John MD

doi: 10.1097/BTO.0000000000000395

Rates of revision hip and knee arthroplasty continue to increase. Patients undergoing revision hip and knee arthroplasty face a different set of challenges than those undergoing primary arthroplasties, with increased rates of medical and surgical complications. Specifically, patients undergoing revision arthroplasty have higher rates transfusion, more unplanned readmissions, greater cardiac and renal complications, and more frequent surgical complications including surgical site infections and need for reoperation and revision surgery. Multiple strategies may be used in an effort to lower these risks, including shifting these surgeries to higher volume medical centers and surgeons, vigorously optimizing revision arthroplasty patients in the preoperative setting, using blood conserving strategies including universal use of tranexamic acid and selective use of blood cell salvage and reinfusion, and closed-incision negative wound pressure therapy to decrease rates of wound complications and surgical site infections.

Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY

This project was supported by an unrestricted grant from KCI, an Acelity company. Project management support was provided by MedicusWorks.

H.J.C. is a paid consultant for KCI, an Acelity Company, and is on their speaker’s bureau. T.R.H. declares that there is nothing to disclose.

For reprint requests, or additional information and guidance on the techniques described in the article, please contact H. John Cooper, MD, at or by mail at Department of Orthopedic Surgery, Columbia University Medical Center, 622 W 168th St, PH-11, New York, NY 10032. You may inquire whether the author(s) will agree to phone conferences and/or visits regarding these techniques.

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