We compared the length of hospitalisation, rate of infection, dislocation of the hip and revision, and mortality following primary hip and knee arthroplasty for osteoarthritis in patients with Alzheimer’s disease (n = 1064) and a matched control group (n = 3192). The data were collected from nationwide Finnish health registers. Patients with Alzheimer’s disease had a longer peri-operative hospitalisation (median 13 days vs eight days, p < 0.001) and an increased risk for hip revision with a hazard ratio (HR) of 1.76 (95% confidence interval (CI) 1.03 to 3.00). Dislocation was the leading indication for revision. There was no difference in the rates of infection, dislocation of the hip, knee revision and short-term mortality. In long-term follow-up, patients with Alzheimer’s disease had a higher mortality (HR 1.43; 95% CI 1.22 to 1.70), and only one third survived ten years post-operatively. Increased age and comorbidity were associated with longer peri-operative hospitalisation in patients with Alzheimer’s disease.

Cite this article: Bone Joint J 2015;97-B:654–61.

We evaluated the duration of hospitalisation, occurrence of infections, hip dislocations, revisions, and mortality following primary hip and knee replacement in 857 patients with Parkinson’s disease and compared them with 2571 matched control patients. The data were collected from comprehensive nationwide Finnish health registers. The mean follow-up was six years (1 to 13). The patients with Parkinson’s disease had a longer mean length of stay (21 days [1 to 365] vs 13 [1 to 365] days) and an increased risk for hip dislocation during the first post-operative year (hazard ratio (HR) 2.33, 95% confidence intervals (CI) 1.02 to 5.32). There was no difference in infection and revision rates, and one-year mortality. In longer follow-up, patients with Parkinson’s disease had higher mortality (HR 1.94, 95% CI 1.68 to 2.25) and only 274 (34.7%) were surviving ten years after surgery. In patients with Parkinson’s disease, cardiovascular and psychiatric comorbidity were associated with prolonged hospitalisation and cardiovascular diseases also with increased mortality.

Cite this article: Bone Joint J 2014;96-B:486–91.

Objective: Hospital volume is a known indicator for orthopaedic adverse events in patients undergoing total hip replacement. The aim of the current study was to evaluate the effect of hospital volume on the length of stay, re-admissions and complications of THR on a population-based level in Finland.

Methods: Using the information from the Hospital Discharge Registry and that of four other National databases, 28,218 THRs performed for primary osteoarthritis were identified for the period covering 1998 to 2005. Hospitals were classified into four groups according to the number of primary and revision hip and knee replacements performed on an annual basis over the whole study period: 1–100 (Group 1), 101–300 (Group 2), 301–600 (Group 3) and 601 or over (Group 4). Logistic regression analysis and generalized linear models were used to study the effect of hospital volume on the length of stay, unscheduled re-admissions, re-operations, dislocations and infections.

Results: The lengths of both the surgical treatment period and the uninterrupted institutional care were shorter for the very high volume hospitals (Group 4) than for the low volume hospitals (Group 1) (p< 0.0001). The odds ratio for dislocations (0.71, 95% CI 0.56–0.91) was significantly lower in the high volume hospitals (Group 3), than in the low volume hospitals (Group 1, the reference group).

Conclusion: Specialization of hip replacements by high volume hospitals should reduce costs by significantly shortening length of stay, and may reduce the dislocation rate.