Clinical Orthopaedics and Related Research

, Volume 467, Issue 1, pp 213–218 | Cite as

Early Mortality after Modern Total Hip Arthroplasty

  • Michael Aynardi
  • Luis Pulido
  • Javad Parvizi
  • Peter F. Sharkey
  • Richard H. Rothman
Symposium: Papers Presented at the Hip Society Meetings 2008

Abstract

Because of improvements in surgical technique, anesthesia, and rehabilitation, mortality after hip arthroplasty may be on the decline. The purpose of this study was to determine the 90-day mortality rate after uncemented total hip arthroplasty (THA) performed under regional anesthesia. We retrospectively reviewed 7478 consecutive patients undergoing cementless primary or revision THA between January 2000 and July 2006. Patient survivorship was established and causes of death were obtained by accessing the Social Security Death Index, Centers for Disease Control and Prevention National Death Index, and State Departments of Vital Statistics. There were two intraoperative deaths from cardiac arrest. The overall 30- and 90-day mortality rates were 0.24% (18 of 7478) and 0.55% (41 of 7478), respectively. Thirty-day mortality after primary THA was low at 0.13% (eight of 6272). The most common cause of death was cardiovascular-related. Mortality after modern THA seems to have remained very low despite the availability of this procedure to patients of all ages and comorbidities.

Level of Evidence: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

References

  1. 1.
    Andersen LJ, Poulsen T, Krogh B, Nielsen T. Postoperative analgesia in total hip arthroplasty: a randomized double-blinded, placebo-controlled study on peroperative and postoperative ropivacaine, ketorolac, and adrenaline wound infiltration. Acta Orthop. 2007;78:187–192.PubMedCrossRefGoogle Scholar
  2. 2.
    Barrett J, Losina E, Baron JA, Mahomed NN, Wright J, Katz JN. Survival following total hip replacement. J Bone Joint Surg Am. 2005;87:1965–1971.PubMedCrossRefGoogle Scholar
  3. 3.
    Blom A, Pattison G, Whitehouse S, Taylor A, Bannister G. Early death following primary total hip arthroplasty: 1727 procedures with mechanical thrombo-prophylaxis. Acta Orthop. 2006;77:347–350.PubMedCrossRefGoogle Scholar
  4. 4.
    Burke WV, Orishimo KF, McAuley JP, Engh CA. Midterm radiographic comparison of cementless acetabular shells containing lateralized and nonlateralized liners. J Arthroplasty. 2006;21:1099–1104.PubMedCrossRefGoogle Scholar
  5. 5.
    Chang RW, Pellisier JM, Hazen GB. A cost-effectiveness analysis of total hip arthroplasty for osteoarthritis of the hip. JAMA. 1996;275:858–865.PubMedCrossRefGoogle Scholar
  6. 6.
    Coventry MB, Beckenbaugh RD, Nolan DR, Ilstrup DM. 2,012 total hip arthroplasties. A study of postoperative course and early complications. J Bone Joint Surg Am. 1974;56:273–284.PubMedGoogle Scholar
  7. 7.
    Danesh-Clough T, Bourne RB, Rorabeck CH, McCalden R. The mid-term results of a dual offset uncemented stem for total hip arthroplasty. J Arthroplasty. 2007;22:195–203.PubMedCrossRefGoogle Scholar
  8. 8.
    Dearborn JT, Harris WH. Postoperative mortality after total hip arthroplasty. An analysis of deaths after two thousand seven hundred and thirty-six procedures. J Bone Joint Surg Am. 1998;80:1291–1294.PubMedGoogle Scholar
  9. 9.
    Doro C, Dimick J, Wainess R, Upchurch G, Urquhart A. Hospital volume and inpatient mortality outcomes of total hip arthroplasty in the United States. J Arthroplasty. 2006;21:10–16.PubMedCrossRefGoogle Scholar
  10. 10.
    Havelin LI, Engesaeter LB, Espehaug B, Furnes O, Lie SA, Vollset SE. The Norwegian Arthroplasty Register: 11 years and 73,000 arthroplasties. Acta Orthop Scand. 2000;71:337–353.PubMedCrossRefGoogle Scholar
  11. 11.
    Keith I. Anaesthesia and blood loss in total hip replacement. Anaesthesia. 1977;32:444–450.PubMedCrossRefGoogle Scholar
  12. 12.
    Kreder HJ, Berry GK, McMurtry IA, Halman SI. Arthroplasty in the octogenarian: quantifying the risks. J Arthroplasty. 2005;20:289–293.PubMedCrossRefGoogle Scholar
  13. 13.
    Krishnan E, Fries JF, Kwoh CK. Primary knee and hip arthroplasty among nonagenarians and centenarians in the United States. Arthritis Rheum. 2007;57:1038–1042.PubMedCrossRefGoogle Scholar
  14. 14.
    Kurtz S, Lau E, Halpern M, Ong K. Trend shows growing orthopedic surgery case load. Will surgeons be able to keep up? Mater Manag Health Care. 2006;15:61–62.PubMedGoogle Scholar
  15. 15.
    Kurtz S, Mowat F, Ong K, Chan N, Lau E, Halpern M. Prevalence of primary and revision total hip and knee arthroplasty in the United States from 1990 through 2002. J Bone Joint Surg Am. 2005;87:1487–1497.PubMedCrossRefGoogle Scholar
  16. 16.
    Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am. 2007;89:780–785.PubMedCrossRefGoogle Scholar
  17. 17.
    Levine B, Kaplanek B, Scafura D, Jaffe WL. Rehabilitation after total hip and knee arthroplasty: a new regimen using Pilates training. Bull NYU Hosp Jt Dis. 2007;65:120–125.PubMedGoogle Scholar
  18. 18.
    Lie SA, Engesaeter LB, Havelin LI, Furnes O, Vollset SE. Early postoperative mortality after 67,548 total hip replacements: causes of death and thromboprophylaxis in 68 hospitals in Norway from 1987 to 1999. Acta Orthop Scand. 2002;73:392–399.PubMedCrossRefGoogle Scholar
  19. 19.
    Lie SA, Engesaeter LB, Havelin LI, Gjessing HK, Vollset SE. Mortality after total hip replacement: 0–10-year follow-up of 39,543 patients in the Norwegian Arthroplasty Register. Acta Orthop Scand. 2000;71:19–27.PubMedCrossRefGoogle Scholar
  20. 20.
    Lieberman JR, Huo MM, Hanway J, Salvati EA, Sculco TP, Sharrock NE. The prevalence of deep venous thrombosis after total hip arthroplasty with hypotensive epidural anesthesia. J Bone Joint Surg Am. 1994;76:341–348.PubMedGoogle Scholar
  21. 21.
    Lubbeke A, Katz JN, Perneger TV, Hoffmeyer P. Primary and revision hip arthroplasty: 5-year outcomes and influence of age and comorbidity. J Rheumatol. 2007;34:394–400.PubMedGoogle Scholar
  22. 22.
    Mahomed NN, Barrett JA, Katz JN, Phillips CB, Losina E, Lew RA, Guadagnoli E, Harris WH, Poss R, Baron JA. Rates and outcomes of primary and revision total hip replacement in the United States medicare population. J Bone Joint Surg Am. 2003;85:27–32.PubMedGoogle Scholar
  23. 23.
    Miller KA, Callaghan JJ, Goetz DD, Johnston RC. Early postoperative mortality following total hip arthroplasty in a community setting: a single surgeon experience. Iowa Orthop J. 2003;23:36–42.PubMedGoogle Scholar
  24. 24.
    Miniño AM, Heron MP, Murphy SL, Kochankek KD. Deaths: Final Data for 2004. Natl Vital Stat Rep. 2007;55:1–119.PubMedGoogle Scholar
  25. 25.
    Nuelle DG, Mann K. Minimal incision protocols for anesthesia, pain management, and physical therapy with standard incisions in hip and knee arthroplasties: the effect on early outcomes. J Arthroplasty. 2007;22:20–25.PubMedCrossRefGoogle Scholar
  26. 26.
    Nunley RM, Lachiewicz PF. Mortality after total hip and knee arthroplasty in a medium-volume university practice. J Arthroplasty. 2003;18:278–285.PubMedCrossRefGoogle Scholar
  27. 27.
    Paavolainen P, Pukkala E, Pulkkinen P, Visuri T. Causes of death after total hip arthroplasty: a nationwide cohort study with 24,638 patients. J Arthroplasty. 2002;17:274–281.PubMedCrossRefGoogle Scholar
  28. 28.
    Parvizi J, Ereth MH, Lewallen DG. Thirty-day mortality following hip arthroplasty for acute fracture. J Bone Joint Surg Am. 2004;86:1983–1988.PubMedGoogle Scholar
  29. 29.
    Parvizi J, Johnson BG, Rowland C, Ereth MH, Lewallen DG. Thirty-day mortality after elective total hip arthroplasty. J Bone Joint Surg Am. 2001;83:1524–1528.PubMedGoogle Scholar
  30. 30.
    Parvizi J, Keisu KS, Hozack WJ, Sharkey PF, Rothman RH. Primary total hip arthroplasty with an uncemented femoral component: a long-term study of the Taperloc stem. J Arthroplasty. 2004;19:151–156.PubMedCrossRefGoogle Scholar
  31. 31.
    Parvizi J, Mui A, Purtill JJ, Sharkey PF, Hozack WJ, Rothman RH. Total joint arthroplasty: When do fatal or near-fatal complications occur? J Bone Joint Surg Am. 2007;89:27–32.PubMedCrossRefGoogle Scholar
  32. 32.
    Parvizi J, Sullivan T, Duffy G, Cabanela ME. Fifteen-year clinical survivorship of Harris-Galante total hip arthroplasty. J Arthroplasty. 2004;19:672–677.PubMedCrossRefGoogle Scholar
  33. 33.
    Sharrock NE, Cazan MG, Hargett MJ, Williams-Russo P, Wilson PD Jr. Changes in mortality after total hip and knee arthroplasty over a ten-year period. Anesth Analg. 1995;80:242–248.PubMedCrossRefGoogle Scholar
  34. 34.
    Shervin N, Rubash HE, Katz JN. Orthopaedic procedure volume and patient outcomes: a systematic literature review. Clin Orthop Relat Res. 2007;457:35–41.PubMedCrossRefGoogle Scholar
  35. 35.
    Sturmer T, Gunther KP, Brenner H. Obesity, overweight and patterns of osteoarthritis: the Ulm Osteoarthritis Study. J Clin Epidemiol. 2000;53:307–313.PubMedCrossRefGoogle Scholar
  36. 36.
    Surdam JW, Archibeck MJ, Schultz SC Jr, Junick DW, White RE Jr. A second-generation cementless total hip arthroplasty mean 9-year results. J Arthroplasty. 2007;22:204–209.PubMedCrossRefGoogle Scholar
  37. 37.
    Tarity TD, Herz AL, Parvizi J, Rothman RH. Ninety-day mortality after hip arthroplasty: a comparison between unilateral and simultaneous bilateral procedures. J Arthroplasty. 2006;21:60–64.PubMedCrossRefGoogle Scholar
  38. 38.
    Tuominen U, Blom M, Hirvonen J, Seitsalo S, Lehto M, Paavolainen P, Hietanieni K, Rissanen P, Sintonen H. The effect of co-morbidities on health-related quality of life in patients placed on the waiting list for total joint replacement. Health Qual Life Outcomes. 2007;5:16.PubMedCrossRefGoogle Scholar
  39. 39.
    Unlu E, Eksioglu E, Aydog E, Aydog ST, Atay G. The effect of exercise on hip muscle strength, gait speed and cadence in patients with total hip arthroplasty: a randomized controlled study. Clin Rehabil. 2007;21:706–711.PubMedCrossRefGoogle Scholar
  40. 40.
    Walker WC, Keyser-Marcus LA, Cifu DX, Chaudhri M. Inpatient interdisciplinary rehabilitation after total hip arthroplasty surgery: a comparison of revision and primary total hip arthroplasty. Arch Phys Med Rehabil. 2001;82:129–133.PubMedCrossRefGoogle Scholar
  41. 41.
    Whittle J, Steinberg EP, Anderson GF, Herbert R, Hochberg MC. Mortality after elective total hip arthroplasty in elderly Americans. Age, gender, and indication for surgery predict survival. Clin Orthop Relat Res. 1993;295:119–126.PubMedGoogle Scholar

Copyright information

© The Association of Bone and Joint Surgeons 2008

Authors and Affiliations

  • Michael Aynardi
    • 1
  • Luis Pulido
    • 1
  • Javad Parvizi
    • 1
  • Peter F. Sharkey
    • 1
  • Richard H. Rothman
    • 1
  1. 1.Rothman Institute of OrthopaedicsThomas Jefferson University HospitalPhiladelphiaUSA

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