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Dislocation is a Leading Cause of Decreased Survival Rate in Primary Total Hip Arthroplasty Performed by Low-Volume
Yuji Kishimoto1, Yoshihiro Kato2, Takahiro Kishi2
1Department of Rheumatology, Japanese Red Cross Tottori Hospital, Tottori, Japan; Department of Orthopedic Surgery, Japanese Red Cross Tottori Hospital, Tottori, Japan.
Insights
Low-volume surgeons performing total hip arthroplasty (THA) face a high risk of dislocation, often requiring early revision surgery. Implementing strategies to mitigate dislocation risk is crucial for improving long-term THA survival rates.
Area of Science:
- Orthopedic Surgery
- Arthroplasty Research
- Patient Outcomes
Background:
- Evaluating complications and long-term survival of primary total hip arthroplasty (THA).
- Assessing outcomes performed by low-volume (LV) surgeons at a LV hospital.
- Determining the relationship between complications and revisions in THA.
Purpose of the Study:
- To evaluate complications and long-term survival of primary total hip arthroplasty (THA).
- To determine the relationship between complications and revisions after THA.
- To assess the impact of low-volume surgical settings on THA outcomes.
Main Methods:
- Retrospective cohort study of 220 THAs in 194 patients with minimum 10-year follow-up.
- Analysis of 90-day mortality, periprosthetic joint infections, dislocations, and fractures.
- Kaplan-Meier survival analysis with revision as the endpoint.
Main Results:
- High rate of dislocation (9.8%) and early revision due to recurrent dislocation (9 out of 10 early revisions).
- Overall survival rate of 94.1% at 10 years, with 15 hips requiring revision surgery.
- Low rates of infection (0.5%) and fracture (1.8%); one 90-day postoperative death.
Conclusions:
- Low-volume surgeons performing THA experience a high risk of dislocation.
- Recurrent dislocations necessitate early revision surgery in a significant number of patients.
- Mitigating dislocation risk is essential for optimizing long-term survival in THA by LV surgeons.
Background:
This study aimed to evaluate the complications and long-term survival of primary total hip arthroplasty (THA) performed by low-volume (LV) surgeons at a LV hospital. We also determined the relationship between complications and revisions.
Methods:
This retrospective cohort study included 220 THAs in 194 patients treated at our institution between 1998 and 2008, who received a minimum of a 10-year follow-up. The median annual THA volume at this hospital was 23 procedures (range, 11-32), and the annual volume per surgeon ranged from 1 to 19. We investigated the 90-day mortality and rates of periprosthetic joint infections, dislocations, and periprosthetic fractures up to the last visit (median follow-up, 11.8 years). Kaplan-Meier survival was calculated with revision as the end point.
Results:
Postoperative infections, dislocations, and fractures at any time during the follow-up period were reported for 1 hip (0.5%), 23 hips (9.8%), and 4 hips (1.8%), respectively. One death occurred within the first 90 days postoperatively. Fifteen hips required revision surgery, and the survival rate was 95.5% at 5 years and 94.1% at 10 years. Of 10 hips that required early revision surgery within 5 years after the index surgery, 9 were revisions to address recurrent dislocation.
Conclusion:
The risk of dislocation was high. A high number of patients who underwent THA by LV surgeons required early revision because of dislocation. To achieve optimal long-term survivorship, LV surgeons should consider measures to reduce the risk of dislocation.
