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Literature Review and Critical Appraisal

Eunice

Literature Review and Critical Appraisal

The PICOT question: What is the duration for recovery (O) for patients with total hip replacement (P) who develop a post-operation infection (I) compared to those who do not develop any infection (C) within the first six weeks of recovery (T)?

Key Terms: Total Hip Replacement Infection; Total Hip Replacement Recovery; Rate of Prosthetic Joint Infection (PJI); Management of PJI.

Strengths and Weaknesses of Literature and Knowledge Gaps

The study by Armor and Kerroumi looked at the patient-specific risk factors for infection following an arthroplasty procedure. The author noted that 80 percent of patients have a modifiable infection risk factor, while the remainders are non-modifiable. The article is useful in directing the current research on the types of patients to include in the study; for example, those with diabetes, renal infection, or are obese, among others, as high-risk patients for PJI. However, the authors did not mention the infection rates for the PJI risk patients for the modifiable risks.

The second study is by Moore et al., who did qualitative research on deep joint infection impact on patients and the experiences the patients had with revision surgery. The authors pointed out that approximately one percent of patients had a PJI following a hip replacement. PJI treatment involves the use of antibiotics and 1 stage revision or more than one operation. The researchers sought to analyze the experience and impact of PJI treatment after stage 1 and 2 revision. The study did not show how long it took for a patient to recover after the PJI though it noted that some patients had up to 15 revisions to rectify the impact of a PJI.

The third study was by Ridgeway et al., who sought to estimate the surgical site infection following a hemiarthroplasty and total hip replacement, as well as the strength in relation to major risk factors. The SSI median detection time was eight days, while bone /joint infection and deep incision infections were 11 days each. For patients with SSI, the length of hospital stay was double. The study, however, did not include patients who were post-discharge with SSI. Although the post-discharge SSI rates are not representative of all SSIs that develop following hip arthroplasty, it is possible that a significant number would be apparent before patient hospital discharge.

The fourth literature review by Soffin and YaDeau discussed the individual components of ERAS efficacy in hip and knee replacement. These included early mobilization after joint arthroplasty; postoperative analgesia; intraoperative anesthetic techniques; preoperative education. The authors identified interventions that were lacking in high-quality evidence, and recommendations for further research followed this. Thus, based on the available evidence, the researchers created a model of the ERAS pathway applicable to perioperative care patients undergoing knee and hip replacement. Although this research showed the treatment options that can be applied and which can be used in the current research search criteria, the duration it takes to recover was not discussed. For this current research, the treatment option will be used in searching for studies that have implemented the same and the duration it takes to recover from PJI.

Lastly, Evans et al. discussed how total hip replacement is a highly effective operation that is common and how all operations would fail in situ, hence the need for patients to understand when such an occurrence would occur. The authors aimed to answer how long a hip replacement can last. The study did not show the duration of a hip replacement following an infection and whether the PJI called for a repeat surgery and, with that, determine the length of hip replacement.

References

Evans, J. T., Evans, J. P., Walker, R. W., Blom, A. W., Whitehouse, M. R., & Sayers, A. (2019). How long does a hip replacement last? A systematic review and meta-analysis of case series and national registry reports with more than 15 years of follow-up. The Lancet, 393(10172), 647-654.

Marmor, S., & Kerroumi, Y. (2016). Patient-specific risk factors for infection in arthroplasty procedure. Orthopaedics & Traumatology: Surgery & Research, 102(1), S113-S119.

Moore, A. J., Blom, A. W., Whitehouse, M. R., & Gooberman-Hill, R. (2015). Deep prosthetic joint infection: a qualitative study of the impact on patients and their experiences of revision surgery. BMJ Open, 5(12).

Ridgeway, S., Wilson, J., Charlet, A., Kafatos, G., Pearson, A., & Coello, R. (2005). Infection of the surgical site after arthroplasty of the hip. The Journal of Bone and joint surgery. British Volume, 87(6), 844-850.

Soffin, E. M., & YaDeau, J. T. (2016). Enhanced recovery after surgery for primary hip and knee arthroplasty: a review of the evidence. BJA: British Journal of Anaesthesia, 117(suppl_3), iii62-iii72.

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Question 

Literature Review and Critical Appraisal

This week’s first assignment is STEP 3 – Literature Review and Critical Appraisal.

The student will complete the following items and submit a Word doc to the assignment link.

  1. Provide a title that conveys or describes the assignment.

    Literature Review and Critical Appraisal

  2. Literature Review – Provide the key terms used to guide the search for the evidence and provide at least five (5) summaries of research studies to support the evidence.
  3. Critical Appraisal of Literature – Discuss the strengths and weaknesses of the evidence, what is known from the evidence and any gaps in knowledge from the research evidence.
  4. References – Cite a minimum of five scholarly references in APA 6th ed format.

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