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Multivariate Analysis of Risk Factors for In-Hospital Dislocation Following Primary Total Hip Arthroplasty
Hunter B Jones1, Andrew J Hinkle1, Yida Liu1
1Department of Orthopedic Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, USA.
Insights
Early dislocation after total hip arthroplasty (THA) is linked to specific patient factors. Female sex, older age, SLE, and Parkinson's disease increase risk, while elective surgery and diabetes may reduce it.
Area of Science:
- Orthopedic Surgery
- Arthroplasty Research
- Patient Safety
Background:
- Early dislocation following primary total hip arthroplasty (THA) is a rare but significant complication.
- This complication leads to increased patient morbidity and substantial healthcare costs.
- Identifying risk factors for early in-hospital dislocation is crucial for prevention.
Purpose of the Study:
- To identify patient characteristics and comorbidities associated with increased early in-hospital dislocation rates after primary THA.
- To inform strategies for reducing the incidence and financial burden of early THA dislocations.
Main Methods:
- Retrospective cohort study utilizing the Nationwide Inpatient Sample (NIS) database (2016-2019).
- Comparison of patients with early periprosthetic dislocation versus those without.
- Univariate and multivariate analyses of patient characteristics and comorbidities using chi-square, Fisher's exact test, and independent sample t-tests.
Main Results:
- Early dislocation occurred in 5,151 of 367,894 patients.
- Increased odds of dislocation were associated with female sex (OR 1.21), age > 70 (OR 1.45), Caucasian ethnicity (OR 1.22), SLE (OR 1.87), and Parkinson's disease (OR 1.93).
- Decreased odds were linked to elective surgery (OR 0.14), tobacco use (OR 0.8), diabetes without complications (OR 0.87), and prior heart valve replacement (OR 0.81).
- Early dislocation significantly increased length of stay (4.7 vs. 2.3 days) and hospital charges (USD $101,517 vs. $66,388).
Conclusions:
- Patient factors such as female sex, age over 70, non-elective surgery, SLE, and Parkinson's disease are associated with early in-hospital dislocation after THA.
- These findings can guide intraoperative implant selection and postoperative protocols for high-risk patients.
- Mitigating early instability can reduce patient morbidity and the financial impact on healthcare systems.
Abstract:
Background: Early dislocation following primary total hip arthroplasty (THA) is a rare but devastating complication and represents a source of patient morbidity and financial burden to the healthcare system. The objective of this study was to identify patient characteristics and comorbidities that are associated with increased early in-hospital dislocation rates following primary THA. Methods: A retrospective cohort study was conducted using patient data from the Nationwide Inpatient Sample (NIS) database; we identified patients who had undergone THA from 2016 to 2019 and compared those with an early periprosthetic dislocation prior to discharge to those without. The patient characteristics and comorbidities were compared using univariate analysis with a subsequent investigation of statistically significant variables using multivariate analysis. The variables were compared using chi square, Fisher's exact test, and independent sample t-tests with data assessed using odds ratio with 95% confidence intervals. Results: A total of 5151 patients sustained an early dislocation compared to 362,743 who did not. Those who sustained an in-hospital dislocation were more likely to share the following characteristics: female sex (OR 1.21, p < 0.01), age > 70 (OR 1.45, p < 0.01), Caucasian ethnicity (OR 1.22, p < 0.01), SLE (OR 1.87, p < 0.01), and Parkinson's disease (OR 1.93, p < 0.01). Certain characteristics were also associated with decreased odds of having an in-hospital dislocation including elective surgery (OR 0.14, p < 0.01), tobacco use (OR 0.8, p < 0.01), diabetes without complications (OR 0.87, p < 0.01), and a history of heart valve replacement (OR 0.81, p < 0.01). The length of stay was significantly longer (4.7 days vs. 2.3 days) as was the total hospital charges (USD $101,517 vs. USD $66,388) for the early in-hospital dislocation group. Conclusions: Several patient characteristics and comorbidities are associated with early in-hospital dislocation episodes following total hip arthroplasty including female sex, age > 70, non-elective surgery, SLE, and Parkinson's. This information may be useful to help guide intraoperative implant selection and/or postoperative protocol in select patient populations to limit early instability as well as decrease the financial burden associated with this postoperative complication.
