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Öğe Aspirin is an effective prophylaxis for venous thromboembolism after revision hip and knee arthroplasty(2024) Yılmaz, Mehmet Kürşat; Abbaszadeh, Ahmad; Restrepo, Camilo; Azboy, İbrahim; Parvizi, JavadBackground: Venous thromboembolism (VTE) following revision total joint arthroplasty (TJA) poses significant risks despite prophylactic measures. The optimal VTE prophylaxis agent for revision TJA remains unclear. This study aimed to compare aspirin against various anticoagulant agents regarding efficacy and safety in preventing symptomatic VTE events after revision TJA. Methods: A retrospective analysis included 4,575 patients undergoing revision TJA between 2008 and 2020. Of these, 2,091 received aspirin, while 2,484 received other anticoagulants. Demographic, procedural, and outcome data were collected. Logistic regression models were used to identify predictors of symptomatic VTE. Results: The aspirin group showed a significantly lower incidence of symptomatic VTE compared to the other anticoagulant group (0.53 versus 2.54%, P < .001). Logistic regression confirmed a higher risk of VTE with other anticoagulants (odds ratio: 0.2 to 0.26, P < .001), while blood transfusion (odds ratio: 2.72, P = .001) were identified as risk factors. Conclusions: This study demonstrated that aspirin is a viable and potentially safer option than other anticoagulants, exhibiting comparable efficacy in preventing VTE events in revision TJA. Balancing effectiveness and safety is crucial, considering patient-specific risk factors and bleeding tendencies. This large cohort study demonstrated that aspirin was associated with a more effective and safer VTE prophylaxis agent, compared to other anticoagulants, in patients undergoing revision TJA.Öğe Aspirin provides adequate vte prophylaxis for patients undergoing hip preservation surgery, including periacetabular osteotomy(Oxford University Press, 2018) Azboy, İbrahim; Kheir, Michael M.; Huang, Ronald; Parvizi, JavadThere are no dear guidelines regarding optimal venous thromboembolism (VTE) prophylaxis for patients undergoing hip preservation surgery (HPS), in particular pelvic osteotomy, which is considered to be a major orthopaedic procedure. The aim of this study was to determine the efficacy of aspirin for VTE prophylaxis in a large cohort of patients undergoing femoroacetabular osteoplasty (FAO) and periacetabular osteotomy (PAO). This was a retrospective study of prospectively collected data on patients undergoing HPS. A total of 603 patients (643 cases) underwent FAO and 80 patients (87 cases) underwent PAO between 2003 and 2016. The mean age of patients was 34.3 years (range 14.3-68.1 years). The type of VTE prophylaxis administered changed over time with earlier patients receiving warfarin (44 cases), followed by aspirin at 325 mg twice daily (448 cases), and most recently aspirin 81 mg twice daily (238 cases). The complications of symptomatic pulmonary embolism (PE), deep venous thrombosis (DVT) and major bleeding events within 90 days of surgery were documented. There were zero patients that developed major bleeding events or required evacuation of a hematoma. One patient who underwent FAO and received aspirin 325 mg, developed post-operative symptomatic DVT. One patient who underwent PAO and received aspirin 325 mg developed DVT and PE. This study demonstrates that the incidence of VTE following joint preservation procedure is acceptably low. Administration of aspirin to patients undergoing FAO or PAO appears to be adequate in reducing the risk of VTE. Only two patients in this cohort developed VTE following HPS.Öğe Bilateral femoroacetabular impingement: What is the fate of the asymptomatic hip?(Lıppincott Williams & Wilkins, 2019) Azboy, İbrahim; Ceylan, Hasan Hüseyin; Groff, Hannah; Vahedi, Hamed; Parvizi, JavadBackground Bilateral symptomatic femoroacetabular impingement (FAI) is common. However, the fate of asymptomatic hip in patients with the radiographic diagnosis of bilateral FAI and unilateral symptoms remains unknown. Questions/purposes (1) What is the likelihood of the asymptomatic hip becoming painful in patients with unilateral symptoms but with radiographic evidence of bilateral femoroacetabular impingement? (2) What radiological and clinical factors are associated with the development of symptoms in an asymptomatic hip diagnosed with FAI? Methods A longitudinally maintained institutional FAI database was queried to collect relevant data for this retrospective study. To answer our research questions, we created a cohort of patients with bilateral radiographic signs of FAI but only unilateral symptoms at the time of initial presentation. Between 2004 and 2016, a senior surgeon (JP) at one institution treated 652 patients for hip pain determined to be from FAI, a diagnosis we made based on clinical symptoms, physical exam, and diagnostic imaging. We excluded 95 patients (15%) because of inadequate data or other diagnoses, which left 557 patients. Of those, 170 patients (31%) had bilateral radiological diagnosis of FAI, and 88 (52%) of them had bilateral hip symptoms, and so were excluded. Of the remaining 82 patients, eight (10%) underwent bilateral FAI surgery under the same anesthetic despite having only unilateral symptoms, leaving 74 for analysis in this study. Patients were followed with annual clinic visits, or contacted by phone and electronically. We defined onset of symptoms using a modified Harris Hip Score (mHHS) or the University of California at Los Angeles (UCLA) activity scale, and used a logistic regression model to identify factors associated with the development of symptoms. Results Of the 74 patients with bilateral FAI and an asymptomatic hip at initial presentation, 60 (81%) became symptomatic at a mean 2 years (range, 0.3-11 years) followup. Of these 60 patients, 43 (72%) eventually underwent subsequent surgical intervention. After controlling for potential confounding variables such as sex, age, BMI, history of trauma we identified that reduced neck-shaft angle (r =-0.243, p = 0.009), increased lateral center-edge angle (r = 0.123, p = 0.049), increased alpha angle (r = 0.069, p = 0.025), and younger age (r =-0.071, p = 0.046) were associated with the development of symptoms in the contralateral hip. With the numbers available, none of the other examined variables such as sex, BMI, history of trauma, psychiatric condition, employment, Tonnis grade, Tonnis angle, crossover sign, type of impingement, and joint congruency were found to be associated with symptom progression. Conclusions Bilateral FAI may be observed about one-third of patients. Most patients with unilateral symptomatic FAI and radiographic diagnosis of bilateral FAI in this cohort became symptomatic relatively quickly and most of them underwent subsequent surgical intervention in the contralateral hip. Reduced neck-shaft angle, increased lateral center-edge angle, increased alpha angle, and younger age were associated with symptom development in the contralateral hip. Hip preservation surgeons may use the finding of this study to counsel patients who present with bilateral FAI but only unilateral symptoms about the natural history of their condition. Level of Evidence Level III, therapeutic study.Öğe Diagnosis of periprosthetic joint infection: The utility of biomarkers in 2023(MDPI, 2023) Yılmaz, Mehmet Kürşat; Abbaszadeh, Ahmad; Tarabichi, Saad; Azboy, İbrahim; Parvizi, JavadPeriprosthetic joint infection (PJI) is a rare yet devastating complication following total joint arthroplasty (TJA). Early and accurate diagnosis of PJI is paramount in order to maximize the chances of successful treatment. However, we are yet to identify a single "gold standard" test for the diagnosis of PJI. As a result, the diagnosis of PJI is often challenging. Currently, the 2018 ICM definition of PJI is the only validated diagnostic criteria available. This article will review the importance of serum and synovial biomarkers in the diagnosis of PJI. In addition, it will provide a brief overview of the emerging modalities for the identification of infections in this setting.Öğe Differences in reported outcomes in industry-funded vs nonfunded studies assessing thromboprophylaxis after total joint arthroplasty(Churchill Livingstone Inc Medical Publishers, 2018) Groff, Hannah; Azboy, İbrahim; Parvizi, JavadBackground: There are numerous studies discussing thromboprophylaxis after total joint arthroplasty (TJA), with varying conclusions. Patient inclusion criteria may be different for each study, which may lead to selection bias and misrepresentation of data. This study aimed to investigate if industry funding impacted patient demographics and overall reported outcomes of studies analyzing venous thromboembolism (VTE) prevention after TJA. Methods: Electronic searches were completed using Ovid, PubMed, and Embase databases. Studies were included if (1) they are published in the English language between 2000 and 2016; (2) they included patients undergoing total hip arthroplasty (THA) or total knee arthroplasty (TKA); and (3) they evaluated prevention and control of postoperative VTE with at least one of the following thromboprophylactic agents: aspirin, enoxaparin, dalteparin, dabigatran, apixaban, rivaroxaban, dabigatran, ximelagatran, fondaparinux, or coumadin. Data were extracted and analyzed via mixed-effect logistic regression. Results: Fifty-seven studies were included; 29 were industry funded, and 28, nonfunded. There were no significant differences between patient's age, body mass index, or revision exclusions between funded and nonfunded studies. Funded studies reported less pulmonary embolisms, fewer events of major bleeding, and significantly less 90-day mortality compared with nonfunded studies. Conclusion: Industry-funded studies reported less pulmonary embolisms, major bleeding, and mortality compared with nonfunded studies. Detailed demographic data were missing from the literature, and we were unable to demonstrate the cause of different reported outcomes between industry-funded and nonfunded studies. Further investigations should be aimed toward understanding how funded studies report less adverse outcomes in analyzing VTE after TJA.Öğe Evidence-based approach for prevention of surgical site infection(2024) Yılmaz, Mehmet Kürşat; Çelik, Nursanem; Tarabichi, Saad; Abbaszadeh, Ahmad; Parvizi, JavadPeriprosthetic joint infection (PJI) is regarded as a critical factor contributing to the failure of primary and revision total joint arthroplasty (TJA). With the increasing prevalence of TJA, a significant increase in the incidence of PJI is expected. The escalating number of cases, along with the significant economic strain imposed on healthcare systems, place emphasis on the pressing need for development of effective strategies for prevention. PJI not only affects patient outcomes but also increases mortality rates, thus its prevention is a matter of vital importance. The longer-term survival rates for PJI after total hip and knee arthroplasty correspond with or are lower than those for prevalent cancers in older adults while exceeding those for other types of cancers. Because of the multifaceted nature of infection risk, a collaborative effort among healthcare professionals is essential to implementing diverse strategies for prevention. Rigorous validation of the efficacy of emerging novel preventive techniques will be required. The combined application of these strategies can minimize the risk of infection, thus their comprehensive adoption is important. Collectively, the risk of PJI could be substantially minimized by application of a multifaceted approach implementing these strategies, leading to improvement of patient outcomes and a reduced economic burden.Öğe Is aspirin an effective prophylaxis against venous thromboembolism in patients undergoing routine total knee or total hip arthroplasty?(2025) Parsa, Ali; Tuncay, İbrahim; Vahedi, Hamed; Azboy, İbrahim; Marin Pena, Oliver; Hozack, William; Parvizi, Javad...Öğe Is there a role for reinforcing soft-tissue repairs or flaps for patients who have abductor deficiency?(2025) Karalar, Şahin; Azboy, İbrahim; Başarır, Kerem; Unnanuntana, Aasis; Yang, Zhi; Parvizi, JavadIs there a role for reinforcing soft-tissue repairs or flaps for patients who have abductor deficiency? Response/Recommendation: Reinforcing soft-tissue repairs, either alone or in combination with muscle flaps, may provide mild to moderate improvement in clinical outcomes in patients who have abductor deficiency undergoing revision total hip arthroplasty (THA). Patients should be informed regarding persistent limping after surgery. Level of Evidence: Limited. Expert Vote: agree 87.4%, disagree 7.4%, abstain 5.2%.Öğe Low-dose aspirin is adequate for venous thromboembolism prevention following total joint arthroplasty: a systematic review(Churchill Livingstone Inc., 2020) Azboy, İbrahim; Groff, Hannah; Goswami, Karan; Vahedian, Mohammed; Parvizi, JavadBackground: Patients undergoing total joint arthroplasty (TJA) are at risk of developing venous thromboembolism (VTE) without adequate prophylaxis. Since the American Academy of Orthopedic Surgeons issued guidelines in 2007 recommending aspirin 325 mg bis in die for 6 weeks, aspirin has been favored as the main VTE prophylaxis. However, the appropriate dose and duration of aspirin are not well-studied. This systematic review aims to identify any differences between high and low dose as well as duration for aspirin thromboprophylaxis after TJA as outlined by previous studies. Methods: A search was performed using Ovid MEDLINE, EMBASE, and PubMed, including articles up to July 2016. Studies were included if they contained at least 1 cohort that underwent TJA with aspirin as the sole chemoprophylaxis and reported either (1) symptomatic VTE or (2) secondary outcomes such as major bleeding or 90-day mortality. Results: Forty-five papers were included. There were no significant differences in symptomatic pulmonary embolism, symptomatic deep vein thrombosis, 90-day mortality, or major bleeding between patients receiving low-dose or high-dose aspirin. Patients treated with aspirin for <4 weeks had a higher risk of major bleeding (1.59%) vs patients treated for 4 weeks (0.15%), which may be attributed to premature cessation or differential reporting. Patients treated with aspirin for <4 weeks had a statistically higher 90-day mortality (1.95%) vs patients treated for 4 weeks (0.07%). There was no significant difference between incidence of pulmonary embolism or deep vein thrombosis and the durations of aspirin treatment. Conclusion: This review suggests that low-dose aspirin is not inferior to high-dose aspirin for VTE thromboprophylaxis in TJA patients. Additionally, patients treated with aspirin for less than 4 weeks may have a higher risk of major bleeding and 90-day mortality compared to patients treated for a longer duration.Öğe Mini-Open femoroacetabular osteoplasty: Risk factors for failure and conversion to hip arthroplasty(Lippincott Williams & Wilkins, 2020) Ceylan, Hasan Hüseyin; Vahedi, Hamed; Azboy, İbrahim; Rezaie, Arash Aali; Parvizi, JavadBackground: Surgical treatment of femoroacetabular impingement (FAI) has been increasing over the past decade with reports of favorable results in alleviating patient symptoms. However, progression of osteoarthritis in these patients may necessitate total hip arthroplasty (THA) for the treatment of unresolved or recurrent hip pain and accompanying disability. Identifying the risk factors for disease progression and treatment failure can help orthopaedic surgeons to select the appropriate patients for joint-preservation procedures and allow more informative discussions. Methods: With use of the prospective database of hip-preservation surgery at our institution, 652 patients (324 men and 328 women) with FAI who had undergone femoroacetabular osteoplasty (FAO) between December 2004 and April 2016 were identified. Treatment failure was defined as the need for THA. At the latest follow-up, 68 (9.08%)of 749 hips had undergone THA because of the recurrence of symptoms and the development of osteoarthritis. The groups of patients who had or had not undergone conversion to THA were compared with respect to age, sex, body mass index (BMI), surgeon experience, duration of preoperative symptoms, preoperative and postoperative alpha angles, radiographic parameters of hip dysplasia, a perioperative chondral lesion, labral abnormalities and interventions, acetabular retroversion, and severity of osteoarthritis (Tonnis grade). Results: The mean age (and standard deviation) at the time of the index FAO was 41.9 +/- 10.5 years for patients who had had a failure of FAO, compared with 33.4 +/- 11.1 years for those who had not. Risk factors for treatment failure included a longer mean symptomatic period before the FAO procedure, older age, higher mean BMI, the presence of hip dysplasia, acetabular retroversion, higher preoperative alpha angle, a full-thickness acetabular chondral lesion, Tonnis grade-1 and 2 osteoarthritis, labral hypertrophy, and total labral resection during FAO. The rate of failure was related to the experience of the surgeon, with fewer failures occurring in the later years of surgery as compared with the earlier years. Conclusions: The present study identified a number of variables that influence the outcome of FAO. Surgeons performing hip-preservation procedures should be aware of these risk factors for failure, and a more cautious approach is recommended for patients with these risk factors.Öğe Reply to letter to editor: Low-dose aspirin is adequate for venous thromboembolism prevention following total joint arthroplasty: A systematic review(Churchill Livingstone Inc Medical Publishers, 2020) Azboy, İbrahim; Groff, Hannah; Parvizi, JavadWe thank Dr Dorr for his interest in our article and for pointingout some important questions. We would like to thank Dr. Dorr andother investigators for the sentinel studies that supported the useof aspirin for VTE prophylaxis. The efforts by leaders such as DrDorr, Dr Salvati and Dr Lotke have led to wide adoption of aspirinas the safest and efficacious VTE prophylaxis for patients undergoing joint arthroplasty.Öğe Reply to the letter to the editor: Bilateral femoroacetabular impingement: What is the fate of the asymptomatic hip?(Lippincott Williams and Wilkins, 2019) Azboy, İbrahim; Parvizi, JavadWe thank Dr. Kohno for his interest in our article and for pointing out some important questions that would be beneficial to the surgeons who treat hip pain in young adults. We defined developmental dysplasia of the hip (DDH) as a lateral center-edge angle that is less than 20°, and borderline dysplasia as a lateral center-edge angle between 20° and 25°Öğe The natural course of serum D-Dimer, C-Reactive protein, and erythrocyte sedimentation rate levels after uneventful primary total joint arthroplasty(Churchill Livingstone Inc Medical Publishers, 2021) Azboy, İbrahim; Çatal, Bilgehan; Başarır, Kerem; Mutlu, Müren; Bilgen, Ömer Faruk; Parvizi, JavadBackground: This study aimed to assess the baseline levels of D-dimer, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) and monitor the natural course of these serum markers after uneventful primary total joint arthroplasty. Methods: This prospective study enrolled 81 patients undergoing primary total knee arthroplasty or total hip arthroplasty. The level of serum D-dimer, CRP, and ESR was measured preoperatively and on postoperative days 1, 3, 5, 15, and 45. Mean peak values, peak times, and distribution were compared between D-Dimer, CRP, and ESR. Results: The mean preoperative serum D-dimer, CRP, and ESR level was 412 +/- 260 (range 200-980) ng/mL, 2.93 +/- 2.1 (range 1-18) mg/L, and 22.88 +/- 17.5 (range 3-102) mm/h, respectively. The highest mean peak for D-dimer, CRP, and ESR was at postoperative day 1, 3, and 5, respectively. Conclusion: D-dimer levels reached peak levels on postoperative day 1 and then declined rapidly to a plateau level by postoperative day 3. A second, albeit small, peak in the level of D-dimer occurred on postoperative day 15. The level of CRP and ESR remained elevated for much longer with CRP returning to baseline on postoperative day 45 and the level of ESR had not returned back to normal on postoperative day 45.Öğe Venous thromboembolism in orthopedic surgery: Global guidelines(AVES, 2023) Uzel, Kadir; Azboy, İbrahim; Parvizi, JavadVenous thromboembolism (VTE) is a severe complication that can occur after major orthopedic procedures. As VTE-related morbidity and mortality are a significant concern for both medical professionals and patients, and preventative measures are typically employed. Multiple organizations, including the American College of Chest Physicians (ACCP) and the American Academy of Orthopedic Surgeons (AAOS), have developed guidelines for VTE prophylaxis specifically in patients undergoing joint replacement procedures. However, recently, the International Consensus Meeting (ICM) was convened, which brought together over 600 experts from 68 countries and 135 international societies. These experts, spanning a range of medical disciplines including orthopedic surgery, anesthesia, cardiology, hematology, vascular, and internal medicine, conducted a comprehensive review of the literature using a strict Delphi process to generate practical recommendations for VTE prophylaxis across all types of orthopedic procedures. This review article summarizes some of the recommendations of the ICM.Öğe Venous thromboembolism prophylaxis after hip preservation surgery: A review and presentation of institutional experience(Oxford University Press, 2018) Rezaie, Arash Aali; Azboy, İbrahim; Parvizi, JavadVenous thromboembolism (VTE) is a serious complication after major orthopedic procedures. The best options for prevention of the VTE are still debated. The most popular evidence-based guidelines for prevention and treatment of VTE in orthopedic surgery addressed the total hip or knee arthroplasty and hip fractures as the major orthopedic surgeries. Majority of studies have evaluated the different modalities of the VTE prophylaxis in patients undergiong hip or knee arthroplasty. Hip preservation surgeries (HPS) including mini-open femoroacetabular osteoplasty, surgical dislocation of the hip, arthroscopic procedures, and periacetabular osteotomy (PAO) are gained popularity in recent two decades. The majority of these patients are young, healthy and active and may not be considered at high risk for VTE. The frequency of VTE in patients undergoing PAO seems to be low between 0 and 5%. There is a paucity of data regarding rates of VTE in young healthy patients undergoing HPS as well as the optimal prevention methods for VTE. Hence current VTE prevention guidelines do not cover HPS adequately. We aimed to review the available literature regarding VTE events and VTE prophylaxis options after HPS. We discussed the available and potential options for prophylaxis of VTE events in these procedures along with our experience in a large cohort of hip preservation surgery.
