While there are risks with any surgery, a new study finds that dislocation and hospital-acquired pneumonia are modifiable risk factors associated with mortality in patients who undergo revision total hip arthroplasty for a periprosthetic fracture.
THA Revisions: Dislocation, Pneumonia Are Modifiable Risk Factors
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Secondary#periprostheticfractures#dislocation#hospitalacquiredpneumonia#revisiontha
The study, “Modifiable risk factors for mortality in revision total hip arthroplasty for periprosthetic fracture,” was published in the April 2020 issue of The Bone & Joint Journal.
The researchers reviewed the electronic records of consecutive patients undergoing revision THA for periprosthetic hip fracture between December 2011 and October 2018. Data was collected on age, sex, BMI (body mass index), American Society of Anesthesiologists (ASA) classification, the preoperative serum level of hemoglobin, time to surgery, operating time, blood transfusion, length of hospital stay, and postoperative surgical and medical complications.
The records of 203 patients were reviewed. A little more than half of the patients were female and the mean age was 78 years (44 to 100). The median time to surgery was three days (interquartile range, 2 to 55).
The mortality rate at one year was 13.8% (n = 28). And the two most common complications were dislocation (n = 22, 10.8%) and hospital-acquired pneumonia within 80 days of surgery (n = 25, 12%).
According to multivariate analysis, the rate of mortality one year after surgery was five times higher in patients who had a dislocation [OR, 5.03 (95% CI, 1.60 to 15.83); p = 0.006]. The rate of mortality for patients who developed hospital-acquired mortality was four times higher. Time to surgery did not appear to be a risk factor.
The researchers wrote, “This study suggests that surgeons should consider increasing constraint to reduce the risk of dislocation, and the early involvement of a multi-disciplinary team to reduce the risk of hospital-acquired pneumonia. We found no evidence that the time to surgery affected mortality, which may allow time for medical optimization, surgical planning, and resource allocation.”
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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