Clinical Orthopaedics and Related Research®

, Volume 470, Issue 2, pp 490–496 | Cite as

Age and Obesity Are Risk Factors for Adverse Events After Total Hip Arthroplasty

  • James I. HuddlestonEmail author
  • Yun Wang
  • Carlos Uquillas
  • James H. Herndon
  • William J. Maloney
Symposium: Papers Presented at the Annual Meetings of The Hip Society



Defining the epidemiology of adverse events after THA will aid in the development of strategies to enhance perioperative care.


We identified (1) risk factors for adverse events in Medicare beneficiaries while hospitalized after THA and (2) trends in the rates of adverse events.

Patients and Methods

Data were abstracted from medical records of 1809 Medicare beneficiaries who underwent THA from 2002 to 2007. We used the hierarchical generalized linear modeling approach to assess the odds of change in adverse events over time, the association of adverse events with outcomes, and the relationship of adverse events with patient characteristics by modeling the log-odds of adverse events as a function of demographic and clinical variables adjusted for year variable.


The overall rate of adverse events was 5.8%; the 30-day mortality rate was 1.00%. Increased age, obesity, and year of procedure were risk factors for experiencing any adverse event. Annual rates of adverse events from 2002 to 2007 were 9.1%, 8.2%, 4.9%, 4.1%, 3.5%, and 3.0%, respectively. Experiencing any adverse event was associated with an increased length of stay and an increased chance of readmission but not with an increased chance of mortality. The annual rate of all adverse events decreased from 2002–2004 to 2005–2007 (odds ratio = 0.83; 95% confidence interval, 0.74–0.92).


Older and obese patients should be counseled regarding their increased risk for the development of adverse events after THA. The cause of the decline in the rate of adverse events between two time periods is unclear and warrants further investigation to confirm and identify the cause.


Chronic Obstructive Pulmonary Disease Medicare Beneficiary Index Hospitalization Current Procedural Terminology National Surgical Quality Improvement Program 
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  1. 1.
    Agency for Healthcare Policy and Research. Trends in Hospital Procedures on Black Patients and White Patients: 1980–1987. AHCPR Publication Number 94-0003. Rockville, MD: Agency for Healthcare Policy and Research; 1994.Google Scholar
  2. 2.
    Bozic KJ, Chiu VW, Takemoto SK, Greenbaum JN, Smith TM, Jerabek SA, Berry DJ. The validity of using administrative claims data in total joint arthroplasty outcomes research. J Arthroplasty. 2010;25:58–61.PubMedCrossRefGoogle Scholar
  3. 3.
    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
  4. 4.
    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
  5. 5.
    Hunt DR, Verzier N, Abend SL, Lyder C, Jaser LJ, Safer N, Davern P. Fundamentals of Medicare patient safety surveillance: intent, relevance, and transparency. In: Henriksen K, Marks ES, Lewin DI, eds. Advances in Patient Safety: From Research to Implementation. Volume 2. Concepts and Methodology. AHCPR Publication Number 05-0021-2. Rockville, MD: Agency for Healthcare Research and Quality; 2005.Google Scholar
  6. 6.
    Ibrahim SA, Stone RA, Han X, Cohen P, Fine MJ, Henderson WG, Khuri SF, Kwoh CK. Racial/ethnic differences in surgical outcomes in veterans following knee or hip arthroplasty. Arthritis Rheum. 2005;52:3143–3151.PubMedCrossRefGoogle Scholar
  7. 7.
    Institute of Medicine. To Err Is Human: Building a Safer Health System. Washington, DC: National Academy Press; 2000.Google Scholar
  8. 8.
    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
  9. 9.
    Lawrence RC, Helmick CG, Arnett FC, Deyo RA, Felson DT, Giannini EH, Heyse SP, Hirsch R, Hochberg MC, Hunder GG, Liang MH, Pillemer SR, Steen VD, Wolfe F. Estimates of the prevalence of arthritis and selected musculoskeletal disorders in the United States. Arthritis Rheum. 1998;41:778–799.PubMedCrossRefGoogle Scholar
  10. 10.
    Lopez JP, Burant CJ, Siminoff LA, Kwoh CK, Ibrahim SA. Patient perceptions of access to care and referrals to specialists: a comparison of African-American and white older patients with knee and hip osteoarthritis. J Natl Med Assoc. 2005;97:667–673.PubMedGoogle Scholar
  11. 11.
    Mahomed NN, Barrett J, 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
  12. 12.
    National Joint Registry. National Joint Replacement Registry of England and Wales 4th Annual Report. 2007. Available at: Accessed June 17, 2011.
  13. 13.
    National Service Scotland. Scottish Arthroplasty Project Annual Report 2007. Available at: Accessed June 17, 2011.
  14. 14.
    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

Copyright information

© The Association of Bone and Joint Surgeons® 2011

Authors and Affiliations

  • James I. Huddleston
    • 1
    Email author
  • Yun Wang
    • 2
    • 3
  • Carlos Uquillas
    • 1
  • James H. Herndon
    • 4
  • William J. Maloney
    • 1
  1. 1.Department of Orthopaedic SurgeryStanford Medicine Outpatient CenterRedwood CityUSA
  2. 2.Qualidigm IncMiddletownUSA
  3. 3.Harvard School of Public HealthBostonUSA
  4. 4.Department of Orthopaedic Surgery, Massachusetts General HospitalHarvard Medical SchoolBostonUSA

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