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Causes of death after total hip arthroplasty: a nationwide cohort study with 24,638 patients
Pekka Paavolainen1, Eero Pukkala, Pekka Pulkkinen
1Division of Orthopaedic Surgery, Surgical Hospital, University Central Hospital, and National Agency for Medicines, Helsinki, Finland. pekka.paavolainen@hus.fi
Insights
Patients undergoing total hip arthroplasty (THA) showed a lower mortality risk compared to the general population. This study investigated mortality causes in THA patients, finding reduced risks for major disease categories.
Area of Science:
- Orthopedic Surgery
- Public Health
- Epidemiology
Background:
- Total hip arthroplasty (THA) is a common procedure for hip joint issues.
- Long-term survival and mortality causes following THA require ongoing investigation.
Purpose of the Study:
- To assess the mortality risk and causes of death in a nationwide cohort of primary total hip arthroplasty patients.
- To identify specific disease categories with altered mortality rates post-THA.
Main Methods:
- Utilized nationwide Finnish THA registry data from 1980.
- Followed 24,638 primary THA patients for mortality until December 31, 1996.
- Analyzed causes of death using ICD-10 classification and calculated standardized mortality ratios (SMRs).
Main Results:
- Overall standardized mortality ratio (SMR) was 0.69, indicating lower mortality than expected.
- Significantly lower SMRs observed for cancers, accidents, cardiovascular diseases, and respiratory diseases.
- A consistent decline in SMRs was noted for dementia, Alzheimer's disease, diabetes, myocardial infarction, hypertension, and cerebrovascular diseases.
Conclusions:
- Total hip arthroplasty patients exhibit a reduced overall mortality risk.
- Factors beyond the arthroplasty itself, such as improved patient selection and lifestyle, may contribute to lower mortality.
- The findings suggest potential benefits of THA on long-term health outcomes, warranting further research into contributing factors.
Abstract:
Based on the nationwide registration of the total hip arthroplasties (THAs) in Finland since 1980, a cohort of 24,638 patients with primary THA was gathered and followed for causes of death until December 31, 1996. The causes of death were divided into 20 main categories according to the classification of diseases ICD-10. The number of person-years was 153,410, and the mean length of follow-up of a person was 6.2 years. During the follow-up, 4,626 patients died; the expected number was 6,746. The standardized mortality ratio (SMR) was 0.69 (95% confidence interval; 0.67-0.70), without any difference between men and women. The total risk increased during the follow-up, with the highest being 0.84 (95% confidence interval, 0.81-0.87). Among the ICD categories, there were significantly low SMRs for cancers (0.54), accidents (0.74), cardiovascular diseases (0.70), and respiratory diseases (0.46). Among the diseases, there was a constant and significant decline of the SMR for dementia and Alzheimer's disease (0.50), diabetes (0.40), myocardial infarction (0.73), hypertension (0.68), other ischemic diseases (0.70), other heart diseases (0.57), and cerebrovascular diseases (0.70). The explanation for the decreased SMRs seems to be attributed to factors other than the THA per se, such as preoperative patient selection, more active lifestyle after THA, and possibly the use of anti-inflammatory drugs.