Ten-Year Trends in Medical Complications Following 540,623 Primary Total Hip Replacements from a National Database

Partridge, Thomas; Jameson, Simon; Baker, Paul; Deehan, David J.; Mason, James; Reed, Mike

doi:10.2106/jbjs.16.01198

Cited by 53 publications

(41 citation statements)

References 43 publications

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“…'major' versus 'minor' complications), reporting base (e.g. single-centre cohorts versus nationwide registries), and length of follow up [10][11][12][13][14] . For example, 90-day venous thromboembolism rates reported in a nationwide database analysis in South Korea were 3.9% for THA and 3.8% for TKA, whereas in-hospital symptomatic DVT rates as reported in a systematic review were 0.26% and 0.63% for THA and TKA respectively, and PE rates at 0.14% and 0.…”

Section: Introductionmentioning

confidence: 99%

Complications to 6 months following total hip or knee arthroplasty: Observations from an Australian clinical outcomes registry

Heo

Harris

Naylor

et al. 2020

Preprint

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Background: Total hip and total knee arthroplasty (THA/TKA) are increasing in incidence annually. While these procedures are effective in improving pain and function, there is a risk of complications. Methods: Using data from an arthroplasty registry, we described complication rates including reasons for reoperation and readmission from the acute period to six months following THA and TKA in an Australian context. Data collection at 6 months was conducted via telephone interview, and included patient-reported complications such as joint stiffness, swelling and paraesthesia. We used logistic regression to identify risk factors for complications. Results: In the 8,444 procedures included for analysis, major complications were reported by 9.5% and 14.4% of THA and TKA patients, respectively, whilst minor complications were reported by 34.0% and 46.6% of THA and TKA patients, respectively. Overall complications rates were 39.7% and 53.6% for THA and TKA patients, respectively. In THA patients, factors associated with increased risk for complications included increased BMI, previous THA and bilateral surgery, whereas in TKA patient factors were heart disease, neurological disease, and pre-operative back pain and arthritis in a separate joint. Female gender and previous TKA were identified as protective factors for minor complications in TKA patients.Conclusion: We found moderate rates of major and high rates of minor postoperative complications following THA and TKA in Australia and have identified several patient factors associated with these complications. Efforts should be focused on identifying patients with higher risk and optimising pre- and post-operative care to reduce the rates of these complications.

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Section: Introductionmentioning

confidence: 99%

Complications to 6 months following total hip or knee arthroplasty: Observations from an Australian clinical outcomes registry

Heo

Harris

Naylor

et al. 2020

Preprint

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“…The mortality in 90 days of Rudasill SE's study is 0.8%, while we have no patient died in three months after surgery. A ten-year national database from the UK also showed postoperative complications reduced year by year in THA, although the levels of comorbidity elevating [30]. Second, some THA-related complications such as dislocation, fracture, wound-healing delay, and vein thrombosis were not included by Rudasill SE.…”

Section: Discussionmentioning

confidence: 99%

Preoperative Elevated International Normalized Ratio Cannot Increase Transfusion or Complication in Primary Total Hip Arthroplasty: A Retrospective Study of 552 Cases

Peng¹,

Zeng²,

Zeng³

et al. 2020

Preprint

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Background: Verify if the elevated preoperative International Normalized Ratio (INR) can increase transfusion and complication rate in primary total hip arthroplasty.Methods: We retrospectively reviewed the database of adults who underwent primary total hip arthroplasty between 2014 to 2018 by the same surgeon. 552 cases were assigned into 3 groups by preoperative INR class: INR≤0.9, 0.9＜INR＜1.0, and INR≥1.0 eventually. We regarded the transfusion rate as the primary outcome. We also included perioperative blood loss, maximum Hb-drop, postoperative anemia needs medicine, length of stay (LOS), re-operation, the complication rate in 90 days and mortality as the secondary outcomes. Univariable analyses were utilized to compare baselines and outcomes between groups. Binary Logistic Regression was used to adjust differences of baselines among groups.Results: All the cases had an INR＜1.5. Among all the cases, 93(16.8%) had INR≤0.9, 268 (48.6%) had 0.9＜INR＜1.0, and 191 (34.6%) had INR≥1.0, respectively. In the univariable analyses, with the INR elevated, The transfusion rates increased from 1.08% for INR≤0.9, 1.12% for 0.9＜INR＜1.0 to 5.76% for INR≥1.0 (p＜0.05). The overall complication rate increased from 10.8% for INR≤0.9, 16.4% for 0.9＜INR＜1.0 to 22.5% for INR≥1.0 (p＜0.05). When controlling for the demographics and comorbidities characteristics, there was no statistically significant difference when evaluating the odds of transfusion nor overall complication rate between the groups (p＞0.05).Conclusions: The transfusion and complication rate cannot increase along with the INR elevated in primary THA. With the improvement of arthroplasty protocol and use of tranexamic acid, the INR＜1.5 was still a conventional safe threshold.

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“…Recent studies have suggested that overall rates of VTE after major orthopedic surgery are falling. A study from a national database from England and Wales of 10‐year trends (2005‐2014) in medical complications in 540 623 patients undergoing THA found that despite a population with increasing levels of comorbidity, the 90‐day mortality rate decreased from 0.60% to 0.15%, the 30‐day DVT rate decreased from 1.15% to 0.28%, and the 30‐day PE rate decreased from 0.77% to 0.40% . A recent systematic review of 255 studies that included almost 6.3 million patients found a consistent decline in mortality within 3 months after elective THA or TKA (from 1.15% pre‐1980 to 0.24% post‐2000) that was independent of method of prophylaxis .…”

Section: Epidemiology and Trends Over Time In Vte Occurrence After Mamentioning

confidence: 99%

What’s new in VTE risk and prevention in orthopedic surgery

Kahn

Shivakumar

2020

Research and Practice in Thrombosis and Haemostasis

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A State of the Art lecture titled “What’s New in VTE Risk and Prevention in Orthopedic Surgery” was presented at the ISTH congress in 2019. Patients undergoing orthopedic surgery have long been recognized to be at increased risk of venous thromboembolism (VTE) and were among the first patient groups to be studied in VTE prophylaxis trials. From the late 1950s to 2010s, prophylaxis trials in major orthopedic surgery tended to focus on venographic deep vein thrombosis and assessed thromboprophylaxis in all patients based on a population approach. In general, anticoagulants were favored over mechanical prophylaxis or aspirin, and longer‐duration prophylaxis was favored over shorter durations. As discussed in this paper, more recently, orthopedic prophylaxis has started to become more nuanced and individualized. Modern trials are focusing on symptomatic VTE as outcomes; there has been a resurgence in interest in aspirin for prophylaxis, and there has been a slow move to studying ways to evaluate VTE risk in patients undergoing orthopedic surgery and recommending thromboprophylaxis to patients based on individual attributes, in whom risk stratification and weighing of benefit versus risk of thromboprophylaxis is becoming key. We also touch on VTE risk and guideline recommendations to prevent VTE in 2 other commonly encountered orthopedic populations: patients undergoing knee arthroscopy and those with distal leg fractures. Finally, we summarize relevant new data on this topic presented during the 2019 ISTH annual congress in Melbourne.

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Ten-Year Trends in Medical Complications Following 540,623 Primary Total Hip Replacements from a National Database

Cited by 53 publications

References 43 publications

Complications to 6 months following total hip or knee arthroplasty: Observations from an Australian clinical outcomes registry

Complications to 6 months following total hip or knee arthroplasty: Observations from an Australian clinical outcomes registry

Preoperative Elevated International Normalized Ratio Cannot Increase Transfusion or Complication in Primary Total Hip Arthroplasty: A Retrospective Study of 552 Cases

What’s new in VTE risk and prevention in orthopedic surgery

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