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Complications of Total Hip Arthroplasty: Standardized List, Definitions, and Stratification Developed by The Hip
William L Healy1,2, Richard Iorio3, Andrew J Clair3
1Kaplan Joint Center, Newton Wellesley Hospital, 2014 Washington Street, Newton, MA, 02462, USA. whealy@partners.org.
Insights
A standardized list of 19 total hip arthroplasty (THA) complications was developed and validated. This will improve patient safety and reporting of THA outcomes.
Area of Science:
- Orthopedic Surgery
- Surgical Outcomes Research
- Patient Safety
Background:
- Reporting of total hip arthroplasty (THA) complications is inconsistent across studies.
- Standardization of THA complications can enhance patient safety and comparative study reporting.
Purpose of the Study:
- To develop a standardized list and definitions for THA complications.
- To stratify and validate these standardized THA complications.
Main Methods:
- A list of THA complications and stratification was proposed by The Hip Society.
- Validation involved expert surveys, case studies, and administrative database analysis.
Main Results:
- 105 members of The Hip Society responded to the survey.
- 21 proposed complications were refined to 19 endorsed THA complications with definitions and stratification.
Conclusions:
- Standardized, stratified, and validated THA complications will advance outcome reporting.
- This framework can improve the assessment of THA by clinical investigators.
Background:
Reporting of complications after total hip arthroplasty (THA) is not standardized, and it is done inconsistently across various studies on the topic. Advantages of standardizing complications include improved patient safety and outcomes and better reporting in comparative studies.
Questions/Purposes:
The purpose of this project was to develop a standardized list of complications and adverse events associated with THA, develop standardized definitions for each complication, and stratify the complications. A further purpose was to validate these standardized THA complications.
Methods:
The Hip Society THA Complications Workgroup proposed a list of THA complications, definitions for each complication, and a stratification scheme for the complications. The stratification system was developed from a previously validated grading system for complications of hip preservation surgery. The proposed complications, definitions, and stratification were validated with an expert opinion survey of members of The Hip Society, a case study evaluation, and analysis of a large administrative hospital system database with a focus on readmissions.
Results:
One hundred five clinical members (100%) of The Hip Society responded to the THA complications survey. Initially, 21 THA complications were proposed. The validation process reduced the 21 proposed complications to 19 THA complications with definitions and stratification that were endorsed by The Hip Society (bleeding, wound complication, thromboembolic disease, neural deficit, vascular injury, dislocation/instability, periprosthetic fracture, abductor muscle disruption, deep periprosthetic joint infection, heterotopic ossification, bearing surface wear, osteolysis, implant loosening, cup-liner dissociation, implant fracture, reoperation, revision, readmission, death).
Conclusions:
Acceptance and use of these standardized, stratified, and validated THA complications and adverse events could advance reporting of outcomes of THA and improve assessment of THA by clinical investigators.
Level Of Evidence:
Level V, therapeutic study.
