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Hip disarticulation: factors affecting outcome
E D Endean1, T H Schwarcz, D E Barker
1Department of Surgery, University of Kentucky Medical Center, Lexington.
Insights
Hip disarticulation surgery outcomes vary by patient factors. Limb ischemia and urgent operations increase complications and mortality, while tumor indications show better survival rates.
Area of Science:
- * Surgical Outcomes
- * Amputation Surgery
- * Patient Risk Stratification
Background:
- * Hip disarticulation is a major surgical procedure often associated with significant risks, particularly in patients with peripheral vascular disease.
- * Understanding patient-specific factors is crucial for predicting clinical outcomes and improving patient management after hip disarticulation.
Purpose of the Study:
- * To identify patient characteristics influencing the clinical outcomes of hip disarticulation.
- * To analyze the impact of surgical indications on morbidity and mortality rates.
- * To determine risk factors for wound complications and postoperative deaths.
Main Methods:
- * Retrospective review of medical records for 53 patients who underwent hip disarticulation between 1966 and 1989.
- * Data collected included surgical indication (limb ischemia, infection, tumor), perioperative wound complications, and postoperative deaths.
- * Statistical analysis to identify significant associations between patient characteristics and outcomes.
Main Results:
- * Overall wound complication rate was 60%, with higher rates in patients with prior above-knee amputation and urgent/emergent operations.
- * Overall mortality rate was 21%, significantly higher for limb ischemia (50%) and infection compared to tumor indications (0%).
- * Urgent/emergent operations and history of cardiac disease were significant predictors of mortality; limb ischemia posed a greater mortality risk than infection.
Conclusions:
- * Hip disarticulation is associated with substantial wound complication rates, influenced by prior amputations and operative urgency.
- * Operative mortality varies significantly by indication, with limb ischemia and infection posing the highest risks.
- * Careful patient selection and management are essential to minimize risks and improve outcomes for hip disarticulation surgery.
Abstract:
Hip disarticulation, especially in patients with peripheral vascular disease, has been associated with high morbidity and mortality rates. This report describes patient characteristics that influence the clinical outcome of hip disarticulation. The medical records of all patients undergoing hip disarticulation from 1966 to 1989 were reviewed for surgical indication, perioperative wound complications, and postoperative deaths. Fifty-three patients underwent hip disarticulation for limb ischemia (10), infection (12), infection and ischemia (14), or tumor (17). The overall incidence of wound complications was 60%, and no significant differences were found among the groups. Prior above-knee amputation and urgent/emergent operations were significantly associated with increased wound complications (p less than 0.05). The overall mortality rate was 21%, ranging from 0% (tumor) to 50% (ischemia) and differed significantly among the groups (p less than 0.02). Mortality was significantly associated with urgent/emergent operations (p less than 0.01). Age, diabetes mellitus, and previous inflow procedures did not influence mortality rates. The presence of limb ischemia influenced mortality rates to a greater extent than did infection, and a history of cardiac disease was statistically predictive of death. Wound complications frequently accompanied hip disarticulation, regardless of operative indication, and were significantly increased by urgent/emergent operations and prior above-knee amputation. Hip disarticulation can be performed with low mortality rates in selected patients. Both limb ischemia and infection substantially increase operative mortality rates.