IN HOSPITAL COMPLICATIONS AFTER TOTAL JOINT ARTHROPLASTY.

Abstract

Background: Total joint arthroplasty (TJA) is a successful procedure. With the demographic tendency towards an elderly society and a relatively high prevalence of arthritis, the number of joint replacement in the US will increase dramatically in the upcoming years. The orthopaedic surgeons need to be aware of the various types of complications in the early hospital setting associated with elective TJA.

Methods: This prospective study reviewed the systemic and local early complications occurring after 13133 TJA which included 7,438 hip arthroplasties (6,010 primary and 1,428 revisions) and 5,695 knee replacements (4,944 primary and 751 revisions). A standardized and detailed form intended to capture all medical and orthopedic complications was devised, plus a full-time research fellow was dedicated to this study. The hospital course of every patient was followed on a daily basis closely. The circumstances leading to the complications and the details of the therapeutic intervention for each complication were recorded.

Results: In general the incidences of complications were higher following TKA compared to THA. There was 26(0.19%) deaths in the cohort that occurred within 10 days after surgery. 329 major (life threatening) complications occurred in the cohort that included myocardial infarction (36), hypotensive crisis (11), pulmonary embolus (145), tachyarrhythmia (93), pulmonary edema (10), acute renal failure (24), stroke (6), bowel obstruction or perforation (3), and pneumothroax (1). There were 37 major local complications. 301 (91%) of these complications occurred within 4 days of index surgery. There were 453 minor systemic complications, mostly related to anemia, and 99 minor local complications in this cohort.

Conclusions: Total joint arthroplasty despite its success can be associated with serious and life threatening complications. The introduction of MIS surgery and the potential for very early discharge of patients undergoing arthroplasty needs to be scrutinized in light of these findings.