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Mortality After Revision Total Hip Arthroplasty
Mitzi S Laughlin1, Emily A Vidal1, Arin A Drtil2
1Fondren Orthopedic Research Institute (FORI), Houston, TX.
Insights
The 2-year mortality rate after revision total hip arthroplasty (revTHA) is 19.5 per 1000. Patients with periprosthetic fractures face a significantly higher mortality risk, emphasizing the need to discuss these risks during patient counseling.
Area of Science:
- Orthopedic Surgery
- Arthroplasty
- Patient Outcomes
Background:
- Complications of revision total hip arthroplasty (revTHA) require careful patient counseling.
- Mortality rates associated with revTHA are not well-defined by indication.
- Determining revTHA mortality rates is crucial for informed patient consent.
Purpose of the Study:
- To determine the overall mortality rate following revision total hip arthroplasty.
- To identify specific mortality rates for revTHA based on the indication for revision.
Main Methods:
- A retrospective review of 596 patients undergoing revTHA between 2012 and 2018.
- Mortality status was ascertained through medical records and death indexes.
- Survival analysis was performed using the last clinical visit date for censoring.
Main Results:
- The overall 2-year mortality rate after revTHA was 19.5 deaths per 1000 (1 in 51).
- Patients with periprosthetic fractures had a significantly higher 2-year mortality rate of 74.5 per 1000 (1 in 13).
- Dislocation/instability showed a trend towards higher mortality (50.3 per 1000), but not statistically significant.
Conclusions:
- Overall revTHA mortality is largely driven by periprosthetic fractures.
- Indications like mechanical loosening or infection did not significantly alter mortality rates.
- Mortality data, stratified by indication, is essential for pre-operative patient counseling.
Background:
In counseling patients about the complications of revision total hip arthroplasty (revTHA), it is imperative that mortality be considered. The actual mortality rate by indication of revision is ill-defined. The purpose of this study is to determine the mortality rate after revTHA.
Methods:
An institutional database identified 596 patients who had undergone revTHA between 2012 and 2018. Medical records, national, state, and local death indexes were queried for mortality status and indication for revTHA. For survivors, the last clinical visit date was used for censoring in the mortality analysis. Mortality rates were calculated for all clinical patients and then by specific indication for revision.
Results:
The overall 2-year mortality rate following revTHA was 19.5 deaths per 1000 or 1 in 51 patients. Patients presenting with a periprosthetic fracture had a significantly higher 2-year mortality rate of 74.5 deaths per 1000 or 1 in 13 patients (P < .001), while an indication of dislocation or instability had a slightly higher 2-year mortality rate of 50.3 per 1000 (1 in 20) but this difference was not significant (P = .531). Other indications such as mechanical loosening or infection did not have a significantly different mortality rate.
Conclusion:
The overall 2-year mortality rate following revTHA was 19.5 deaths per 1000 which was largely attributed to patients with a periprosthetic fracture (74.5 per 1000) with other indications not significantly impacting mortality. Mortality rates and specific rates by indication for revision should be considered when counseling patients prior to revTHA.
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