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Outcomes of total hip arthroplasty in calcium pyrophosphate deposition disease patients
Konstantinos Parperis1, Marios Lampi2, Maria Constantinou2
1Department of Medicine, Division of Rheumatology University of Arizona College of Medicine Phoenix, AZ, USA; University of Cyprus Medical School, Nicosia, Cyprus.
Insights
Total hip arthroplasty (THA) in patients with calcium pyrophosphate deposition (CPPD) disease showed lower mortality but longer hospital stays. CPPD patients were older and had more comorbidities, often discharged to rehabilitation facilities.
Area of Science:
- Orthopedics
- Rheumatology
- Health Services Research
Background:
- Calcium pyrophosphate deposition (CPPD) disease is a crystal-induced arthropathy that can affect joints, including the hip.
- Total hip arthroplasty (THA) is a common procedure for hip osteoarthritis, but outcomes in patients with CPPD disease are less understood.
Purpose of the Study:
- To compare demographics, clinical characteristics, outcomes, and resource utilization of patients undergoing THA with and without CPPD disease.
- To identify specific differences in post-operative results and healthcare resource use between these two patient groups.
Main Methods:
- Utilized the National Inpatient Sample database (2006-2014) to identify THA patients.
- Classified patients into two groups: those with CPPD (using ICD-9 codes) and those without.
- Collected data on demographics, comorbidities, mortality, length of stay (LOS), and costs; analyzed associations using chi-square and t-tests.
Main Results:
- 0.15% of 4,111,808 THA patients had CPPD (mean age 77, 64.2% female).
- CPPD patients were older (77 vs 72.7 years), had higher comorbidity scores (Charlson ≥ 2), but lower mortality (0.7% vs 1.7%).
- CPPD patients experienced longer LOS (6.04 vs 5.15 days) and were more frequently discharged to rehabilitation facilities (42.5% vs 35.3%).
Conclusions:
- Patients with CPPD undergoing THA are generally older with a higher comorbidity burden.
- Despite a higher comorbidity burden, THA in CPPD patients was associated with lower mortality.
- CPPD patients had increased LOS and a greater likelihood of non-home discharge following THA.
Objective:
We aim to examine the demographics, clinical characteristics, outcomes, and resource utilization following total hip arthroplasty (THA) in patients with and without calcium pyrophosphate deposition (CPPD) disease.
Methods:
We queried the National Inpatient Sample database to identify patients who underwent THA between 2006 and 2014. The ICD-9 code 81.51 was used to determine the patients who underwent THA, and of those, we classified 2 groups of patients: (i) those with ICD-9 codes defining CPPD and (ii) those without any CPPD code. Data collection included patient demographics and comorbidities. Outcomes post-THA were mortality, length of stay (LOS), and costs. Associations between CPPD and specific morbidity were evaluated with chi-square tests. T tests were used for continuous variables.
Results:
Among the 4,111,808 patients who underwent THA, 6198 (0.15 %) had CPPD, with a mean age of 77 years and 64.2 % were females. CPPD patients were more likely to be older (mean age 77 vs 72.7 years; p<0.001) than non-CPPD patients. The Charlson Comorbidity Index score ≥ 2 was more frequently seen in CPPD, however, the mortality post-THA was lower in the CPPD patients (0.7 % vs 1.7 %, OR 0.35, 95 % CI 0.26- 0.47). THA in CPPD patients was associated with a longer mean length of stay (LOS) (6.04 vs 5.15 days, OR 1.15, 95 % CI 1.09-1.22) while mean total charges were not statistically different between the 2 groups (p = 0.344). CPPD patients were more likely to be discharged to rehabilitation or other nursing facilities (42.5 % vs 35.3 %, p<0.001). The number of THA procedures increased in both CPPD and non-CPPD patients over time.
Conclusions:
CPPD patients who underwent THA were more likely to be older, with a greater comorbidity burden, longer LOS and discharged to a non-home setting.
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