Medical problems in joint replacement patients: a retrospective study of 243 total hip arthroplasties

Two hundred and forty-three total hip arthroplasties were performed in 217 patients over a five-year period in one institution. Seventy-one per cent had one or more significant preoperative medical problems, 22% being referred for preoperative management to a specialist physician. Thirty per cent of patients experienced re-activity of medical problems after operation; in 41% of patients a physician review was sought while in a further 40% the problems were apparently unnoticed or not acted upon. There was a positive correlation between preoperative and postoperative medical problems (P less than 0.001). Fifteen per cent of patients developed complications and one patient died. There was a highly significant trend towards longer hospital stay in patients with medical problems and complications (P less than 0.001). It is concluded that there is a high incidence of medical problems in joint replacement patients, that these problems have an influence on the morbidity and cost of the procedure, and that management of these problems can be improved.