Incidence and risk factors of in-hospital prosthesis-related complications following total hip arthroplasty: a retrospective Nationwide Inpatient Sample database study

Abstract

Purpose

The occurrence of prosthesis-related complications (PRCs) after total hip arthroplasty (THA) is devastating, commonly meaning implant failure and revision surgery. The purpose was to examine the incidence and risk factors of in-hospital PRCs following THA using a large-scale national database.

Methods

A retrospective database analysis was performed based on Nationwide Inpatient Sample (NIS) from 2005 to 2014. Patients who underwent THA were included. Patient demographics, hospital characteristics, length of stay (LOS), economic indicators, in-hospital mortality, comorbidities, and peri-operative complications were evaluated.

Results

A total of 590,122 THAs were obtained from the NIS database. The general incidence of in-hospital PRCs after THA was 1.96%, with a slight downward trend annually. Dislocation was the most common PRCs (0.23%). Patients with PRCs after THA demonstrated increased LOS, total charges, usage of Medicare, and in-hospital mortality. Risk factors of PRCs included advanced age, female, the Hispanic, the Native American, large hospital, teaching hospital, hospital in the South, Medicaid, Self-pay, alcohol abuse, anemia, coagulopathy, rheumatoid diseases, neurological disorders, depression, paralysis, psychosis, diabetes, fluid and electrolyte disorders, congestive heart failure, chronic pulmonary disease, liver disease, metastatic cancer, and weight loss. Additionally, PRCs were associated with avascular necrosis, ankylosing spondylitis, rheumatoid arthritis, femoral neck fracture, dementia, osteoporosis, acute renal failure, acute myocardial infarction, pneumonia, post-operative delirium, urinary tract infection, deep vein thrombosis, transfusion, sepsis, post-operative shock, wound dehiscence, haemorrhage/seroma/haematoma, and nerve injury.

Conclusion

A relatively low incidence of in-hospital PRCs after THA was identified. It is of benefit to study risk factors of PRCs to ensure the appropriate management and moderate consequences.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2

Data availability

This study is based on data provided by Nationwide Inpatient Sample (NIS) database, part of the Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality. The NIS database is a large publicly available all-payer inpatient care database in the USA. Therefore, individual or grouped data cannot be shared by the authors.

Abbreviations

THA:

total hip arthroplasty

THR:

total hip revision

PRCs:

prosthesis-related complications

PJI:

periprosthetic joint infection

PPF:

periprosthetic fracture

LOS:

length of stay

NIS:

Nationwide Inpatient Sample

ICD-9-CM:

International Classification of Diseases (ninth revision) Clinical Modification

OR:

odds ratio

CI:

confidence interval

AVN:

avascular necrosis

AS:

ankylosing spondylitis

RA:

rheumatoid arthritis

FNF:

femoral neck fracture

References

  1. 1.

    Kong L, Cao J, Zhang Y et al (2017) Risk factors for periprosthetic joint infection following primary total hip or knee arthroplasty: a meta-analysis. Int Wound J 14:529–536. https://doi.org/10.1111/iwj.12640

    Article  PubMed  Google Scholar 

  2. 2.

    Pulido L, Ghanem E, Joshi A et al (2008) Periprosthetic joint infection: the incidence, timing, and predisposing factors. Clin Orthop Relat Res 466:1710–1715. https://doi.org/10.1007/s11999-008-0209-4

    Article  PubMed  PubMed Central  Google Scholar 

  3. 3.

    Bozic KJ, Kurtz SM, Lau E et al (2009) The epidemiology of revision total hip arthroplasty in the United States. J Bone Joint Surg Am 91:128–133. https://doi.org/10.2106/JBJS.H.00155

    Article  PubMed  Google Scholar 

  4. 4.

    Kurtz S, Ong K, Lau E et al (2007) Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am 89:780–785. https://doi.org/10.2106/JBJS.F.00222

    Article  PubMed  Google Scholar 

  5. 5.

    Gwam CU, Mistry JB, Mohamed NS et al (2017) Current epidemiology of revision total hip arthroplasty in the United States: National Inpatient Sample 2009 to 2013. J Arthroplast 32:2088–2092. https://doi.org/10.1016/j.arth.2017.02.046

    Article  Google Scholar 

  6. 6.

    Katz JN, Wright EA, Wright J et al (2012) Twelve-year risk of revision after primary total hip replacement in the U.S. Medicare population. J Bone Joint Surg Am 94:1825–1832. https://doi.org/10.2106/JBJS.K.00569

    Article  PubMed  PubMed Central  Google Scholar 

  7. 7.

    Meek RMD, Norwood T, Smith R et al (2011) The risk of peri-prosthetic fracture after primary and revision total hip and knee replacement. J Bone Joint Surg Br 93:96–101. https://doi.org/10.1302/0301-620X.93B1.25087

    CAS  Article  PubMed  Google Scholar 

  8. 8.

    Sing DC, Barry JJ, Aguilar TU et al (2016) Prior lumbar spinal arthrodesis increases risk of prosthetic-related complication in total hip arthroplasty. J Arthroplasty 31:227–232.e1. https://doi.org/10.1016/j.arth.2016.02.069

    Article  PubMed  Google Scholar 

  9. 9.

    Buller LT, Rosas S, Sabeh KG et al (2018) Hypothyroidism increases 90-day complications and costs following primary total knee arthroplasty. J Arthroplast 33:1003–1007. https://doi.org/10.1016/j.arth.2017.10.053

    Article  Google Scholar 

  10. 10.

    The McMaster Arthroplasty Collaborative (MAC) (2020) Risk factors for periprosthetic joint infection following primary total hip arthroplasty: a 15-year, population-based cohort study. J Bone Joint Surg Am 102:503–509. https://doi.org/10.2106/JBJS.19.00537

    Article  Google Scholar 

  11. 11.

    Kim YH, Choi Y, Kim JS (2009) Influence of patient-, design-, and surgery-related factors on rate of dislocation after primary cementless total hip arthroplasty. J Arthroplast 24:1258–1263. https://doi.org/10.1016/j.arth.2009.03.017

    Article  Google Scholar 

  12. 12.

    Menendez ME, Ring D, Barnes CL (2016) Inpatient dislocation after primary total hip arthroplasty. J Arthroplast 31:2889–2893. https://doi.org/10.1016/j.arth.2016.05.007

    Article  Google Scholar 

  13. 13.

    Bozic KJ, Lau E, Kurtz S et al (2012) Patient-related risk factors for periprosthetic joint infection and postoperative mortality following total hip arthroplasty in Medicare patients. J Bone Joint Surg Am 94:794–800. https://doi.org/10.2106/JBJS.K.00072

    Article  PubMed  Google Scholar 

  14. 14.

    Carli AV, Negus JJ, Haddad FS (2017) Periprosthetic femoral fractures and trying to avoid them: what is the contribution of femoral component design to the increased risk of periprosthetic femoral fracture? Bone Joint J 99-B:50–59. https://doi.org/10.1302/0301-620X.99B1.BJJ-2016-0220.R1

    CAS  Article  PubMed  Google Scholar 

  15. 15.

    Triantafyllopoulos GK, Soranoglou VG, Memtsoudis SG et al (2018) Rate and risk factors for periprosthetic joint infection among 36,494 primary total hip arthroplasties. J Arthroplast 33:1166–1170. https://doi.org/10.1016/j.arth.2017.11.040

    Article  Google Scholar 

  16. 16.

    Zhu Y, Zhang F, Chen W et al (2015) Risk factors for periprosthetic joint infection after total joint arthroplasty: a systematic review and meta-analysis. J Hosp Infect 89:82–89. https://doi.org/10.1016/j.jhin.2014.10.008

    CAS  Article  PubMed  Google Scholar 

  17. 17.

    Lenguerrand E, Whitehouse MR, Beswick AD et al (2018) Risk factors associated with revision for prosthetic joint infection after hip replacement: a prospective observational cohort study. Lancet Infect Dis 18:1004–1014. https://doi.org/10.1016/S1473-3099(18)30345-1

    Article  PubMed  PubMed Central  Google Scholar 

  18. 18.

    Da Assunção RE, Pollard TCB, Hrycaiczuk A et al (2015) Revision arthroplasty for periprosthetic femoral fracture using an uncemented modular tapered conical stem. Bone Joint J 97-B:1031–1037. https://doi.org/10.1302/0301-620X.97B8.34431

    Article  PubMed  Google Scholar 

  19. 19.

    Innmann MM, Streit MR, Bruckner T et al (2018) Comparable cumulative incidence of late periprosthetic femoral fracture and aseptic stem loosening in uncemented total hip arthroplasty—a concise follow-up report at a minimum of 20 years. J Arthroplast 33:1144–1148. https://doi.org/10.1016/j.arth.2017.11.022

    Article  Google Scholar 

  20. 20.

    Gausden EB, Parhar HS, Popper JE et al (2018) Risk factors for early dislocation following primary elective total hip arthroplasty. J Arthroplasty 33:1567–1571.e2. https://doi.org/10.1016/j.arth.2017.12.034

    Article  PubMed  Google Scholar 

  21. 21.

    Janssen L, Wijnands KAP, Janssen D et al (2018) Do stem design and surgical approach influence early aseptic loosening in cementless THA? Clin Orthop Relat Res 476:1212–1220. https://doi.org/10.1007/s11999.0000000000000208

    Article  PubMed  PubMed Central  Google Scholar 

  22. 22.

    Miettinen SSA, Mäkinen TJ, Laaksonen I et al (2017) Early aseptic loosening of cementless monoblock acetabular components. Int Orthop 41:715–722. https://doi.org/10.1007/s00264-016-3254-8

    Article  PubMed  Google Scholar 

  23. 23.

    Darrith B, Courtney PM, Della Valle CJ (2018) Outcomes of dual mobility components in total hip arthroplasty: a systematic review of the literature. Bone Joint J 100-B:11–19. https://doi.org/10.1302/0301-620X.100B1.BJJ-2017-0462.R1

    CAS  Article  PubMed  Google Scholar 

  24. 24.

    Park KJ, Menendez ME, Barnes CL (2017) Perioperative periprosthetic fractures associated with primary total hip arthroplasty. J Arthroplast 32:992–995. https://doi.org/10.1016/j.arth.2016.08.034

    Article  Google Scholar 

  25. 25.

    Fessy MH, Putman S, Viste A et al (2017) What are the risk factors for dislocation in primary total hip arthroplasty ? A multicenter case-control study of 128 unstable and 438 stable hips. Orthop Traumatol Surg Res 103:663–668. https://doi.org/10.1016/j.otsr.2017.05.014

    CAS  Article  PubMed  Google Scholar 

  26. 26.

    Yang S, Halim AY, Werner BC et al (2015) Does osteonecrosis of the femoral head increase surgical and medical complication rates after total hip arthroplasty? A comprehensive analysis in the United States. Hip Int 25:237–244. https://doi.org/10.5301/hipint.5000224

    Article  PubMed  Google Scholar 

  27. 27.

    Sidler-maier CC, Waddell JP (2015) Incidence and predisposing factors of periprosthetic proximal femoral fractures : a literature review. Int Orthop 39:1673–1682. https://doi.org/10.1007/s00264-015-2721-y

    Article  PubMed  Google Scholar 

  28. 28.

    Goodnough LH, Finlay AK, Huddleston JI et al (2018) Obesity is independently associated with early aseptic loosening in primary total hip arthroplasty. J Arthroplast 33:882–886. https://doi.org/10.1016/j.arth.2017.09.069

    Article  Google Scholar 

  29. 29.

    Cherian JJ, Jauregui JJ, Banerjee S et al (2015) What host factors affect aseptic loosening after THA and TKA? Clin Orthop Relat Res 473:2700–2709. https://doi.org/10.1007/s11999-015-4220-2

    Article  PubMed  PubMed Central  Google Scholar 

  30. 30.

    Fineberg SJ, Nandyala SV, Marquez-Lara A et al (2013) Incidence and risk factors for postoperative delirium after lumbar spine surgery. Spine (Phila Pa 1976) 38:1790–1796. https://doi.org/10.1097/BRS.0b013e3182a0d507

    Article  Google Scholar 

  31. 31.

    Newman JM, Sodhi N, Dalton SE et al (2018) Does Parkinson disease increase the risk of perioperative complications after total hip arthroplasty? A nationwide database study. J Arthroplast 33:S162–S166. https://doi.org/10.1016/j.arth.2018.01.006

    Article  Google Scholar 

  32. 32.

    Casp AJ, Montgomery SR Jr, Cancienne JM et al (2019) Osteoporosis and implant-related complications after anatomic and reverse total shoulder arthroplasty. J Am Acad Orthop SurgOnline ahead of print. https://doi.org/10.5435/JAAOS-D-18-00537

  33. 33.

    Khatod M, Cafri G, Namba RS et al (2014) Risk factors for total hip arthroplasty aseptic revision. J Arthroplast 29:1412–1417. https://doi.org/10.1016/j.arth.2014.01.023

    Article  Google Scholar 

  34. 34.

    Del Buono A, Denaro V, Maffulli N (2012) Genetic susceptibility to aseptic loosening following total hip arthroplasty: a systematic review. Br Med Bull 101:39–55. https://doi.org/10.1093/bmb/ldr011

    CAS  Article  PubMed  Google Scholar 

  35. 35.

    Sams JD, Milbrandt JC, Froelich JM et al (2010) Hospital outcome after emergent vs elective revision total hip arthroplasty. J Arthroplast 25:826–828. https://doi.org/10.1016/j.arth.2010.01.097

    Article  Google Scholar 

  36. 36.

    Reeves RA, Schairer WW, Jevsevar DS (2019) The national burden of periprosthetic hip fractures in the US: costs and risk factors for hospital readmission. Hip Int 29:550–557. https://doi.org/10.1177/1120700018803933

    Article  PubMed  Google Scholar 

  37. 37.

    Schwartz BE, Piponov HI, Helder CW et al (2016) Revision total hip arthroplasty in the United States : national trends and in-hospital outcomes. Int Orthop 40:1793–1802. https://doi.org/10.1007/s00264-016-3121-7

    Article  PubMed  Google Scholar 

  38. 38.

    Kurtz SM, Ms ECL, Ong KL et al (2017) Which clinical and patient factors influence the national economic burden of hospital readmissions after total joint arthroplasty ? Clin Orthop Relat Res 475:2926–2937. https://doi.org/10.1007/s11999-017-5244-6

    Article  PubMed  PubMed Central  Google Scholar 

  39. 39.

    Singh JA, Cleveland JD (2018) Medicaid or Medicare insurance payer status and household income are associated with outcomes after primary total hip arthroplasty. Clin Rheumatol 37:2489–2496. https://doi.org/10.1007/s10067-018-4126-y

    Article  PubMed  Google Scholar 

  40. 40.

    Wu C, Qu X, Liu F et al (2014) Risk factors for periprosthetic joint infection after total hip arthroplasty and total knee arthroplasty in Chinese patients. PLoS One 9:e95300. https://doi.org/10.1371/journal.pone.0095300

    Article  PubMed  PubMed Central  Google Scholar 

  41. 41.

    Brimmo O, Glenn M, Klika AK et al (2016) Rivaroxaban use for thrombosis prophylaxis is associated with early periprosthetic joint infection. J Arthroplast 31:1295–1298. https://doi.org/10.1016/j.arth.2015.12.027

    Article  Google Scholar 

  42. 42.

    Kawano S, Sonohata M, Kitajima M et al (2018) Risk factors for the development of nerve palsy following primary total hip arthroplasty. Open Orthop J 12:164–172. https://doi.org/10.2174/1874325001812010164

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Affiliations

Authors

Contributions

All authors contributed to the study conception and design. Material preparation, data collection ,and analysis were performed by Jian Wang, Yichuan Xu, Yuhang Chen, and Qiang Lian. The first draft of the manuscript was written by Qinfeng Yang with revision, guidance, and feedback from Yang Zhang, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Yang Zhang.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethics approval

This article does not contain any studies with human participants or animals performed by any of the authors. This observational study was deemed exempt because it used deidentified publicly available data.

Code availability

R version 3.5.3 (The R Foundation Inc).

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Yang, Q., Wang, J., Xu, Y. et al. Incidence and risk factors of in-hospital prosthesis-related complications following total hip arthroplasty: a retrospective Nationwide Inpatient Sample database study. International Orthopaedics (SICOT) 44, 2243–2252 (2020). https://doi.org/10.1007/s00264-020-04682-y

Download citation

Keywords

  • Prosthesis-related complications
  • Total hip arthroplasty
  • Nationwide Inpatient Sample