Outcomes of Total Hip Arthroplasty in Patients With Acetabular Protrusio
Danielle Greig1, Peter P Hsiue, Clark J Chen
1From the Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA (Dr. Greig, Dr. Hsiue, Mr. Chen, Dr. Trikha, and Dr. Stavrakis), and the Division of Orthopaedic Surgery, University of Toronto, Toronto, Ontario (Dr. Khoshbin), Canada.
Insights
Acetabular protrusio (AP) complicates total hip arthroplasty (THA) with increased risks of bone grafting, transfusions, and fractures. Patients with AP experienced longer hospital stays and higher costs, necessitating careful management.
Area of Science:
- Orthopedic Surgery
- Arthroplasty Research
- Health Services Research
Background:
- Acetabular protrusio (AP) presents unique challenges in total hip arthroplasty (THA) due to altered anatomy and compromised bone stock.
- These factors increase surgical complexity and may impact patient outcomes.
Purpose of the Study:
- To compare outcomes of THA in patients with and without AP using a large national database.
- To identify specific complications and resource utilization differences between the two groups.
Main Methods:
- Analysis of the Nationwide Readmissions Database (2010-2014) for patients undergoing THA.
- Propensity score matching to create comparable cohorts of patients with and without AP.
- Comparison of index hospitalization complications and 90-day postoperative outcomes.
Main Results:
- Patients with AP were older, predominantly female, and had higher comorbidity scores.
- AP group showed significantly increased odds of requiring bone graft, blood transfusion, and periprosthetic fracture.
- Index hospitalization was longer and more costly for patients with AP.
Conclusions:
- Acetabular protrusio is associated with significantly higher complication rates and resource utilization after THA.
- Enhanced preoperative planning and postoperative monitoring are crucial for managing AP patients effectively.
- Optimizing care for AP patients is essential for hospital cost containment and improved patient safety.
Background:
Acetabular protrusio (AP) is associated with distorted anatomic landmarks and insufficient bone stock that increases complexity of total hip arthroplasty (THA). This study used a large national database to compare outcomes after THA in patients with and without AP.
Methods:
The Nationwide Readmissions Database was used to identify patients with and without AP who underwent THA from 2010 to 2014. Primary outcomes analyzed included complications during index hospitalization and within 90 days of THA.
Results:
Propensity score matching generated 4,395 patients without AP and 4,603 patients with AP. Patients with AP were older (68.1 versus 65.2 years, P < 0.0001), more predominantly women (82.1% versus 55.9%), and had more medical comorbidities as measured by the Elixhauser Comorbidity Index (2.29 versus 1.89, P < 0.0001). Patients with AP had an increased risk of requiring bone graft (odds ratio [OR] = 47.97, 95% confidence interval [CI]: 14.27 to 161.22), receiving a blood transfusion (OR = 1.90, 95% CI: 1.57 to 2.29), and suffering a periprosthetic fracture (OR = 2.56, 95% CI: 1.10 to 5.97) within 90 days of THA. Length and cost of index hospitalization were greater for patients with AP (5.0 versus 4.3 days, P = 0.002; $19,211.88 versus $27,736.30, P < 0.0001).
Conclusion:
Given the current emphasis on hospital cost optimization, it is important to ensure that patients with AP are managed appropriately. Attention should be placed on comprehensive preoperative planning and postoperative monitoring in this population.
