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[Are early dislocations still a relevant quality indicator in primary total hip arthroplasty? : An analysis from two
Caroline Voigt1, Philipp Bergschmidt2, Wolfram Mittelmeier3
1Orthopädische Klinik und Poliklinik, Universitätsmedizin Rostock, Doberaner Straße 142, 18057, Rostock, Deutschland. caroline.voigt@med.uni-rostock.de.
Background:
The dislocation rate of primary hip arthroplasty has been reduced since the 1970s to rates of 0.7-8.8%. Dislocations after primary arthroplasty are only recorded in arthroplasty registries when implant components are exchanged. In the EndoCert® certification process, dislocations in the early postoperative phase up to 3 months are additionally assessed without mandatory follow-up. Is early dislocation a significant quality indicator in primary hip arthroplasty?
Material And Methods:
In a joint database (EndoDok®), all dislocations after primary hip endoprostheses at two certified EndoProsthetics Centers of maximum care from various clinic providers were prospectively recorded over at least 3 months postoperatively using the available documents, including discharge, rehabilitation, outpatient, and physicians' reports. All patients who suffered a dislocation were analyzed in comparison to the control group without dislocation. Factors considered included gender, side, age, BMI, ASA, operation time, primary procedure, and prosthesis fixation.
Results:
During the observation period of 9 years, elective primary total hip arthroplasty implantations were performed on a total of 3265 patients according to the same standards. The dislocation rate was low at 0.18% following elective hip arthroplasty. Risk factors such as increased BMI, prosthesis fixation, inclination angle, and operation duration were presented. The dislocation rate was not significantly influenced by training interventions.
Discussion:
In the certification process, complications are consistently evaluated to improve processes. Under the quality-oriented conditions of the EndoCert® system, very low dislocation rates can be achieved in primary endoprosthetics. Even without follow-up examinations, consistent recording of dislocations allows for a comparable evaluation of provider quality and, in particular, provides the prerequisite for the mandatory complication analysis of all reported dislocations.
