MORTALITY AND MORBIDITY FOLLOWING TOTAL HIP ARTHROPLASTY

Abstract

Background: Results after Total Hip Replacement (THR) including prosthetic design, surgical complications and prosthetic survival are frequently reported – however, information on the rate of complications in general is sparse.

Aim and Methods: The aim was to collect information on all complications after THR within the first year after surgery. This study consisted of 500 consecutive patients (386 with primary THR operated due to degenerative osteoarthritis (OA) and 112 with primary THR due to secondary OA or revision THR). These patients were followed by structured interviews at surgery and 3 and 12 months after discharge. Surgical and cardiovascular complications were registered. No interventions related to this study were done. The patients followed the standard care of departments.

Results: 500 patients were included; two withdrew their consent, leaving 498 for the follow up one year after surgery or until death. Of the 498 patients 103 (20.6%) experienced at least one complication related to the operation within the one year observation period. Among the 386 primary THR with degenerative OA the complicationrate was 17.9%.

Of the 498 patients 6.6% experienced one or more symptomatic cardiovascular complications (deep vein thrombosis, pulmonary embolism (PE), myocardial infarction, and stroke, transient ischemic attack or retinal vein thrombosis). In the degenerative OA group 4.7% (95% Cl: 2.6–6.8%) had a cardiovascular event and in the secondary OA + revision group the rate was 13.4% (95% Cl: 10.2–16.6). The rate of complications directly related to the surgery (dislocation, perioperative fracture, bleeding, aseptic loosening, deep infection, peroneal palsy or superficial wound infection) was 15.4% (95% Cl: 12.3–18.6). In the degenerative OA and secondary OA/revision group the rates were: 14.2% and 19.6% respectively. Nine (1.8%) patients died, five of cardiovascular reasons (disseminated intravascular coagulation, PE followed by renal failure, PE followed by cerebral ischemia and stroke), the first three in close relation to the operation.

Discussion: A complication-rate of 20.6% as found in the present study seems to be very high. There is no reason to think that these numbers are not correct. To our knowledge, only one other study has been published with data about complications in general (Williams O., J Arthroplasty17:165–171, 2002). Their results are based on a mix of hospital file data, patient and general practitioner questionnaires with varying response rates – and their findings, although a bit lower in number, support the data from this study. The present study indicates, that there is a need for continuous registration of these common complications– even in the group of primary THR due to degenerative osteoarthritis, usually thought of as being the least complicated. The complication rate must be included in the information given to patients offered THR.