Clinical Orthopaedics and Related Research®

, Volume 471, Issue 2, pp 574–583

Estimating Risk in Medicare Patients With THA: An Electronic Risk Calculator for Periprosthetic Joint Infection and Mortality

  • Kevin J. Bozic
  • Kevin Ong
  • Edmund Lau
  • Daniel J. Berry
  • Thomas P. Vail
  • Steven M. Kurtz
  • Harry E. Rubash
Clinical Research



Although risk factors for periprosthetic joint infection (PJI) and mortality after total hip arthroplasty (THA) have been identified, interactions between specific patient risk factors are poorly understood. Therefore, it is difficult for surgeons to counsel patients on their individual risk of PJI or mortality after THA.


We evaluated the interaction between patient clinical and demographic factors on the risk of PJI and mortality after THA and developed an electronic risk calculator for estimating the patient-specific risk of PJI and mortality in Medicare patients with THA.


We used the Medicare 5% sample claims database to calculate the risk of PJI within 2 years and mortality within 90 days after THA in 53,252 Medicare patients with primary THAs between 1998 and 2009. Logistic regression using 29 comorbid conditions, age, sex, race, and socioeconomic status were used as inputs to develop an electronic risk calculator to estimate patient-specific risk of PJI and mortality after THA.


The overall 2-year risk of PJI and 90-day risk of mortality after primary THA were 2.07% and 1.30%, respectively. White women aged 70 to 74 years with alcohol abuse, depression, electrolyte disorder, peptic ulcer disease, urinary tract infection, rheumatologic disease, preoperative anemia, cardiopulmonary (cardiac arrhythmia, congestive heart failure, ischemic heart disease, chronic pulmonary disease) comorbidities, and peripheral vascular disease were at highest risk for PJI. White women aged 65 to 69 years with electrolyte disorder, hemiplegia/paraplegia, hypertension, hypothyroidism, metastatic tumor, preoperative anemia, coagulopathy, cardiopulmonary (congestive heart failure, chronic pulmonary disease) and psychiatric (psychoses, depression) comorbidities, malignancies, and peripheral vascular disease were at highest risk for mortality. An electronic risk calculator was developed to estimate the risk of PJI and mortality in Medicare patients with THA.


This electronic risk calculator can be used to counsel Medicare patients regarding their patient-specific risks of PJI and mortality after THA.

Level of Evidence

Level II, prognostic study. See the Instructions for Authors for a complete description of levels of evidence.


  1. 1.
    American Academy of Orthopaedic Surgeons. Total hip replacement. Available at: Accessed November 22, 2011.
  2. 2.
    Bozic KJ, Lau E, Kurtz S, Ong K, Berry DJ. Patient-related risk factors for postoperative mortality and periprosthetic joint infection in Medicare patients undergoing TKA. Clin Orthop Relat Res. 2012;470:130–137.PubMedCrossRefGoogle Scholar
  3. 3.
    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
  4. 4.
    Franko OI. Smartphone apps for orthopaedic surgeons. Clin Orthop Relat Res. 2011;469:2042–2048.PubMedCrossRefGoogle Scholar
  5. 5.
    Franko OI, Tirrell TF. Smartphone app use among medical providers in ACGME training programs. J Med Syst. 2012;36:3135–3139.PubMedCrossRefGoogle Scholar
  6. 6.
    Gaston MS, Amin AK, Clayton RA, Brenkel IJ. Does a history of cardiac disease or hypertension increase mortality following primary elective total hip arthroplasty? Surgeon. 2007;5:260–265.PubMedCrossRefGoogle Scholar
  7. 7.
    Hamel MB, Toth M, Legedza A, Rosen MP. Joint replacement surgery in elderly patients with severe osteoarthritis of the hip or knee: decision making, postoperative recovery, and clinical outcomes. Arch Intern Med. 2008;168:1430–1440.PubMedCrossRefGoogle Scholar
  8. 8.
    Lai K, Bohm ER, Burnell C, Hedden DR. Presence of medical comorbidities in patients with infected primary hip or knee arthroplasties. J Arthroplasty. 2007;22:651–656.PubMedCrossRefGoogle Scholar
  9. 9.
    Mantilla CB, Horlocker TT, Schroeder DR, Berry DJ, Brown DL. Frequency of myocardial infarction, pulmonary embolism, deep venous thrombosis, and death following primary hip or knee arthroplasty. Anesthesiology. 2002;96:1140–1146.PubMedCrossRefGoogle Scholar
  10. 10.
    Mariconda M, Galasso O, Costa GG, Recano P, Cerbasi S. Quality of life and functionality after total hip arthroplasty: a long-term follow-up study. BMC Musculoskelet Disord. 2011;12:222.PubMedCrossRefGoogle Scholar
  11. 11.
    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
  12. 12.
    Ong KL, Kurtz SM, Lau E, Bozic KJ, Berry DJ, Parvizi J. Prosthetic joint infection risk after total hip arthroplasty in the Medicare population. J Arthroplasty. 2009;24(6 suppl):105–109.PubMedCrossRefGoogle Scholar
  13. 13.
    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
  14. 14.
    Rat AC, Guillemin F, Osnowycz G, Delagoutte JP, Cuny C, Mainard D, Baumann C. Total hip or knee replacement for osteoarthritis: mid- and long-term quality of life. Arthritis Care Res (Hoboken). 2010;62:54–62.CrossRefGoogle Scholar
  15. 15.
    Rosser BA, Eccleston C. Smartphone applications for pain management. J Telemed Telecare. 2011;17:308–312.PubMedCrossRefGoogle Scholar
  16. 16.
    Surin VV, Sundholm K, Backman L. Infection after total hip replacement: with special reference to a discharge from the wound. J Bone Joint Surg Br. 1983;65:412–418.PubMedGoogle Scholar

Copyright information

© The Association of Bone and Joint Surgeons® 2012

Authors and Affiliations

  • Kevin J. Bozic
    • 1
    • 2
  • Kevin Ong
    • 3
  • Edmund Lau
    • 4
  • Daniel J. Berry
    • 5
  • Thomas P. Vail
    • 1
  • Steven M. Kurtz
    • 3
  • Harry E. Rubash
    • 6
  1. 1.Department of Orthopaedic SurgeryUniversity of California, San FranciscoSan FranciscoUSA
  2. 2.Philip R. Lee Institute for Health Policy StudiesUniversity of California, San FranciscoSan FranciscoUSA
  3. 3.Exponent, IncPhiladelphiaUSA
  4. 4.Exponent, IncMenlo ParkUSA
  5. 5.Department of Orthopaedic SurgeryMayo ClinicRochesterUSA
  6. 6.Department of Orthopaedic SurgeryMassachusetts General HospitalBostonUSA

Personalised recommendations