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[Predictive factors of perioperative morbidity in revision total hip arthroplasty]
S Kinkel1, S Kessler, T Mattes
1Stiftung Orthopädische Universitätsklinik Heidelberg, Abteilung Orthopädie I, Heidelberg, Germany.
Insights
Revision total hip arthroplasty (THA) complications are influenced by revision status and operation duration. Multiple revisions increase risk threefold, while longer surgeries increase it by 1% per minute. Cemented implants in primary revisions also pose a higher risk.
Area of Science:
- Orthopedic Surgery
- Arthroplasty
- Surgical Complications
Context:
- Revision total hip arthroplasty (THA) requires careful management to prevent perioperative morbidity.
- Understanding factors influencing complications is crucial for patient outcomes.
Purpose:
- To assess perioperative complication rates in revision THA.
- To evaluate the impact of patient- and procedure-related variables on these complications.
Summary:
- This retrospective study analyzed 169 revision THA cases, focusing on revision status, operation duration, and implant fixation type.
- Key findings indicate that revision status (primary vs. multiple) and longer operation duration significantly increase perioperative morbidity.
- Primary revisions involving cemented implants showed a higher complication rate compared to non-cemented ones.
Impact:
- Revision status and operation duration are significant predictors of perioperative morbidity in THA revisions.
- Cemented implants in primary revision THA may be associated with increased perioperative risk.
- These findings emphasize the need for pre-operative consideration of these variables to mitigate risks.
Aim:
The awareness and prevention of perioperative morbidity are essential in revision total hip arthroplasty [THA]. Therefore, it was the purpose of this study to assess the rate of perioperative complications following revision THA in order to evaluate the impact of patient- and procedure-related variables.
Methods:
169 consecutive patients with a mean age of 71.7 years suffering from aseptic loosening of their THA were included in this retrospective study. Multivariate logistic regression models with estimation of the odds ratio [OR] and 95% confidence interval [CI] served to analyze the influence of operation duration, gender, revision status, ASA classification, and type of fixation of the primary implant on the perioperative morbidity.
Results:
68.6% of the cases were primary revisions, and 31.4% secondary or multiple revisions. 49.7% of the operations involved exchange of the complete implant whereas 39.1% comprised exchange of the cup and 11.2% exchange of the stem only. Mean operation duration was 130 minutes [min] (range: 40-260 min), and mean intraoperative blood loss was 2.6 L (0.5 to 12 L). The rate of intraoperative complications was 10.1 % with a 6.5 % fracture rate. Postoperatively the complication rate was 25.4% with an 8.3% rate of luxations. 11.8% of the patients had revision within the first three weeks after surgery. Regression models showed the significant impact of revision status (primary vs. secondary or multiple: OR 2.90, 95% CI 1.42-5.92) and operation duration (per min starting from the mean operation time: OR 1.01, 95% CI 1.00-1.02) on the resulting complication rate. Analysis of the perioperative complication rate following primary revisions revealed a significant difference (p = 0.03) between patients with cemented (15/36, 41.7%) and non-cemented (8/45, 17.8%) implants.
Conclusions:
Revision status with a three-fold increase in patients with multiple revisions as well as operation duration with a 1 % increase per min starting from the mean operation time significantly influence the perioperative morbidity. Patients with a first revision, furthermore, seem to be at greater risk for an adverse event perioperatively if their implant is fully cemented. These findings should be taken into account prior to initiating surgery.
