International Journal of Colorectal Disease

, Volume 34, Issue 2, pp 261–267 | Cite as

Risk factors for ileus after hip and knee arthroplasty

  • Antonio KlasanEmail author
  • Fedor Amic
  • Philipp Dworschak
  • Goran Madzarac
  • Thomas Jan Heyse
  • Thomas Neri
Original Article



Postoperative ileus (POI) is one of the complications that can occur after every surgical procedure including arthroplasty. It can have detrimental consequences for the patient and portrays an economic burden on health care systems. The risk factors for POI after arthroplasty described in the literature are scarce and include hip arthroplasty, male gender and previous abdominal surgery. The purpose of the study was to determine the risk factors for POI after hip and knee arthroplasty.


A retrospective review of 2760 patients undergoing primary hip and knee arthroplasty was performed. An in-depth analysis of patient history and physical operative and postoperative course was reviewed and statistically analyzed in a univariate and multivariate setting.


Overall incidence of POI was 0.54%. History of myocardial infarction and chronic kidney disease were statistically significant risk factors for developing POI after arthroplasty with values of p = 0.023 and p = 0.004, respectively. Other risk factors included previous abdominal surgery (p < 0.001) and hip arthroplasty (p = 0.026). Age or gender correlations were not observed.


Although postoperative ileus is an uncommon complication after joint arthroplasty, in addition to the known risk factors of male age, hip arthroplasty, and previous abdominal surgery, this study describes two previously unknown risk factors: chronic kidney disease and history of myocardial infarction. Patients with these risk factors should be monitored closely for developing postoperative ileus.


Ileus Complications Arthroplasty Myocardial infarction Chronic kidney disease 



We would like to thank Thomas Leonhard, Albert Benzing, and Harald Lintl for their help with the study.

Author contributions

AK conceived the study and did the data collection. AK, FA, and GM drafted the manuscript. AK and TN performed the statistical analysis. PD revised the manuscript. TH and TN supervised the study and did the final revision of the manuscript. All authors read and approved the final manuscript.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Jauregui JJ, Cherian JJ, Pierce TP, Beaver WB, Issa K, Mont MA (2015) Long-term survivorship and clinical outcomes following total knee arthroplasty. J Arthroplast 30:2164–2166. CrossRefGoogle Scholar
  2. 2.
    Learmonth ID, Young C, Rorabeck C (2007) The operation of the century: total hip replacement. Lancet 370:1508–1519. CrossRefGoogle Scholar
  3. 3.
    Zhan C, Kaczmarek R, Loyo-Berrios N, Sangl J, Bright RA (2007) Incidence and short-term outcomes of primary and revision hip replacement in the United States. J Bone Joint Surg Am 89:526–533. CrossRefGoogle Scholar
  4. 4.
    Livingston EH, Passaro EP (1990) Postoperative ileus. Dig Dis Sci 35:121–132CrossRefGoogle Scholar
  5. 5.
    Huge A, Kreis ME, Jehle EC, Ehrlein HJ, Starlinger M, Becker HD, Zittel TT (1998) A model to investigate postoperative ileus with strain gauge transducers in awake rats. J Surg Res 74:112–118. CrossRefGoogle Scholar
  6. 6.
    Bederman SS, Betsy M, Winiarsky R, Seldes RM, Sharrock NE, Sculco TP (2001) Postoperative ileus in the lower extremity arthroplasty patient. J Arthroplast 16:1066–1070. CrossRefGoogle Scholar
  7. 7.
    Parvizi J, Han S-B, Tarity TD, Pulido L, Weinstein M, Rothman RH (2008) Postoperative ileus after total joint arthroplasty. J Arthroplast 23:360–365. CrossRefGoogle Scholar
  8. 8.
    Weinstein MA, Keggi JM, Zatorski LE, Keggi KJ (2002) One-stage bilateral total hip arthroplasty in patients > or = 75 years. Orthopedics 25:153–156Google Scholar
  9. 9.
    Pavone V, Johnson T, Saulog PS, Sculco TP, Bottner F (2004) Perioperative morbidity in bilateral one-stage total knee replacements. Clin Orthop Relat Res 421:155–161CrossRefGoogle Scholar
  10. 10.
    Berend KR, Lombardi AV, Mallory TH, Dodds KL, Adams JB (2004) Ileus following total hip or knee arthroplasty is associated with increased risk of deep venous thrombosis and pulmonary embolism. J Arthroplast 19:82–86CrossRefGoogle Scholar
  11. 11.
    O. Vilz T, Stoffels B, Strassburg C, H. Schild H, C. Kalff J (2017) Ileus in adults. Dtsch Arztebl Int 114:508–518 . doi: 10.3238/arztebl.2017.0508Google Scholar
  12. 12.
    Tevis SE, Carchman EH, Foley EF, Harms BA, Heise CP, Kennedy GD (2015) Postoperative ileus–more than just prolonged length of stay? J Gastrointest Surg 19:1684–1690. CrossRefGoogle Scholar
  13. 13.
    Sibia US, Mandelblatt AE, Callanan MA, MacDonald JH, King PJ (2017) Incidence, risk factors, and costs for hospital returns after total joint arthroplasties. J Arthroplast 32:381–385. CrossRefGoogle Scholar
  14. 14.
    Barletta JF, Senagore AJ (2014) Reducing the burden of postoperative ileus: evaluating and implementing an evidence-based strategy. World J Surg 38:1966–1977. CrossRefGoogle Scholar
  15. 15.
    Asgeirsson T, El-Badawi KI, Mahmood A, Barletta J, Luchtefeld M, Senagore AJ (2010) Postoperative ileus: it costs more than you expect. J Am Coll Surg 210:228–231. CrossRefGoogle Scholar
  16. 16.
    Ansari D, Gianotti L, Schröder J, Andersson R (2013) Fast-track surgery: procedure-specific aspects and future direction. Langenbeck’s Arch Surg 398:29–37. CrossRefGoogle Scholar
  17. 17.
    Yang JH, Yoon JR, Oh CH, Kim TS (2012) Primary total knee arthroplasty using rotating-hinge prosthesis in severely affected knees. Knee Surg Sports Traumatol Arthrosc 20:517–523. CrossRefGoogle Scholar
  18. 18.
    Thompson M, Magnuson B (2012) Management of postoperative ileus. Orthopedics 35:213–217. CrossRefGoogle Scholar
  19. 19.
    Vather R, Trivedi S, Bissett I (2013) Defining postoperative ileus: results of a systematic review and global survey. J Gastrointest Surg 17:962–972. CrossRefGoogle Scholar
  20. 20.
    Venara A, Slim K, Regimbeau J-M, Ortega-Deballon P, Vielle B, Lermite E, Meurette G, Hamy A (2017) Proposal of a new classification of postoperative ileus based on its clinical impact-results of a global survey and preliminary evaluation in colorectal surgery. Int J Color Dis 32:797–803. CrossRefGoogle Scholar
  21. 21.
    Ram CVS, Giles TD (2010) The evolving definition of systemic arterial hypertension. Curr Atheroscler Rep 12:155–158. CrossRefGoogle Scholar
  22. 22.
    Harter K, Levine M, Henderson SO (2015) Anticoagulation drug therapy: a review. West J Emerg Med 16:11–17. CrossRefGoogle Scholar
  23. 23.
    Lu L, Liu M, Sun R, Zheng Y, Zhang P (2015) Myocardial infarction: symptoms and treatments. Cell Biochem Biophys 72:865–867. CrossRefGoogle Scholar
  24. 24.
    Cassar A, Holmes DR, Rihal CS, Gersh BJ (2009) Chronic coronary artery disease: diagnosis and management. Mayo Clin Proc 84:1130–1146. CrossRefGoogle Scholar
  25. 25.
    (2010) Diagnosis and classification of diabetes mellitus. Diabetes Care 33:S62–S69 . doi:, 2009
  26. 26.
    Cockcroft DW, Gault MH (1976) Prediction of creatinine clearance from serum creatinine. Nephron 16:31–41. CrossRefGoogle Scholar
  27. 27.
    Thomas R, Kanso A, Sedor JR (2008) Chronic kidney disease and its complications. Prim Care 35:329–vii. CrossRefGoogle Scholar
  28. 28.
    Al Maaieh MA, Du JY, Aichmair A, Huang RC, Hughes AP, Cammisa FP, Girardi FP, Sama AA (2014) Multivariate analysis on risk factors for postoperative ileus after lateral lumbar interbody fusion. Spine 39:688–694. CrossRefGoogle Scholar
  29. 29.
    Fineberg SJ, Nandyala SV, Kurd MF, Marquez-Lara A, Noureldin M, Sankaranarayanan S, Patel AA, Oglesby M, Singh K (2014) Incidence and risk factors for postoperative ileus following anterior, posterior, and circumferential lumbar fusion. Spine J 14:1680–1685. CrossRefGoogle Scholar
  30. 30.
    Ritter MA, Harty LD (2004) Debate: simultaneous bilateral knee replacements: the outcomes justify its use. Clin Orthop Relat Res 428:84–86CrossRefGoogle Scholar
  31. 31.
    Yu C, Tan S, Wang Z, Deng B, Li J, Wang Q, Zhou C, Kang X, Yu Z, Zhuang S (2018) Chronic kidney disease elicits an intestinal inflammation resulting in intestinal dysmotility associated with the activation of inducible nitric oxide synthesis in rat. Digestion 97:205–211. CrossRefGoogle Scholar
  32. 32.
    Vaziri ND, Wong J, Pahl M, Piceno YM, Yuan J, DeSantis TZ, Ni Z, Nguyen T-H, Andersen GL (2013) Chronic kidney disease alters intestinal microbial flora. Kidney Int 83:308–315. CrossRefGoogle Scholar
  33. 33.
    Strid H, Simrén M, Stotzer P-O, Ringström G, Abrahamsson H, Björnsson ES (2003) Patients with chronic renal failure have abnormal small intestinal motility and a high prevalence of small intestinal bacterial overgrowth. Digestion 67:129–137. CrossRefGoogle Scholar
  34. 34.
    Levine B, Kalman J, Mayer L, Fillit HM, Packer M (1990) Elevated circulating levels of tumor necrosis factor in severe chronic heart failure. N Engl J Med 323:236–241. CrossRefGoogle Scholar
  35. 35.
    Sandek A, Bauditz J, Swidsinski A, Buhner S, Weber-Eibel J, von Haehling S, Schroedl W, Karhausen T, Doehner W, Rauchhaus M, Poole-Wilson P, Volk H-D, Lochs H, Anker SD (2007) Altered intestinal function in patients with chronic heart failure. J Am Coll Cardiol 50:1561–1569. CrossRefGoogle Scholar
  36. 36.
    Sandek A, Bjarnason I, Volk H-D, Crane R, Meddings JB, Niebauer J, Kalra PR, Buhner S, Herrmann R, Springer J, Doehner W, von Haehling S, Anker SD, Rauchhaus M (2012) Studies on bacterial endotoxin and intestinal absorption function in patients with chronic heart failure. Int J Cardiol 157:80–85. CrossRefGoogle Scholar
  37. 37.
    Pasini E, Aquilani R, Testa C, Baiardi P, Angioletti S, Boschi F, Verri M, Dioguardi F (2016) Pathogenic gut flora in patients with chronic heart failure. JACC: Heart Failure 4:220–227. Google Scholar
  38. 38.
    Wolthuis AM, Bislenghi G, Lambrecht M, Fieuws S, de Buck van Overstraeten A, Boeckxstaens G, D’Hoore A (2017) Preoperative risk factors for prolonged postoperative ileus after colorectal resection. Int J Colorectal Dis 32:883–890. CrossRefGoogle Scholar
  39. 39.
    Menendez ME, Ring D, Bateman BT (2015) Preoperative opioid misuse is associated with increased morbidity and mortality after elective orthopaedic surgery. Clin Orthop Relat Res 473:2402–2412. CrossRefGoogle Scholar
  40. 40.
    Shi Y, Zhang XP, Qin H, Yu YJ (2017) Naso-intestinal tube is more effective in treating postoperative ileus than naso-gastric tube in elderly colorectal cancer patients. Int J Color Dis 32:1047–1050. CrossRefGoogle Scholar
  41. 41.
    Lambrichts DPV, Boersema GSA, Tas B, Wu Z, Vrijland WW, Kleinrensink G-J, Jeekel J, Lange JF, Menon AG (2017) Nicotine chewing gum for the prevention of postoperative ileus after colorectal surgery: a multicenter, double-blind, randomised, controlled pilot study. Int J Color Dis 32:1267–1275. CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Antonio Klasan
    • 1
    • 2
    Email author
  • Fedor Amic
    • 3
  • Philipp Dworschak
    • 2
  • Goran Madzarac
    • 4
  • Thomas Jan Heyse
    • 5
  • Thomas Neri
    • 6
  1. 1.Department for OrthopedicsSchwarzwald Baar KlinikumDonaueschingenGermany
  2. 2.Center for Orthopedics and TraumatologyUniversity Hospital MarburgMarburgGermany
  3. 3.Department of Abdominal SurgeryClinical Hospital DubravaZagrebCroatia
  4. 4.Department for Thoracic Surgery, Clinic for Lung DiseasesUniversity Hospital ZagrebZagrebCroatia
  5. 5.Orthomedic Frankfurt OffenbachOffenbachGermany
  6. 6.Department of Orthopaedic SurgeryUniversity Hospital St EtienneSaint-Priest-en-JarezFrance

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