Risk Factor Analysis for 30-Day Mortality After Primary THA in a Single Institution


The purpose of this study was to determine the prevalence of, and associated risk factors for, 30-day perioperative death following primary total hip arthroplasty (THA). Data of all the patients were compiled from the computerized total joint registry at a single institution. Between May 1993 and May 2006, 3,232 consecutive primary THA (2,453 elective and 779 nonelective) were performed. Eleven deaths occurred during the first month after surgery (0.34 %). Thirty-day mortality rate after elective THA was 0.08 % (two of 2,453 IC 95 %(0–0.4)). The 30-day mortality rate after nonelective THA was 1.15 % (nine of 779 IC 95 %(0.7–2.4). To analyze the factors that could have contributed with death, we conducted a 4-to-1 nested case–control study. Control cases were strictly matched by sex, age, surgeon, prosthesis fixation mode, and date of surgery. Conditional logistic regression was used to evaluate the association of risk factors with mortality. Elective surgery was associated with a lower risk of mortality with an odds ratio (OR) of 0.07 (95 % CI 0.008–0.6);p = 0.015. American Society of Anesthesiologists (ASA) score III–IV increased the mortality risk 13 times (OR 13.7; 95 % CI 1.6–114.8). Cardiovascular disease increased the risk for mortality eight times (OR 8.83 (95 % CI 1.78–43.6). Time delay before surgery showed a trend towards significance (p = 0.06). Aggressive vs. nonaggressive thromboembolism prophylaxis and the amount of blood transfusions required were not associated with a higher risk of death. Patients undergoing a THA due to fractures, patients with high ASA score, and those with cardiovascular disease were the highest risk factors for 30-day mortality after primary THA.

This is a preview of subscription content, log in to check access.


  1. 1.

    Mullen JO, Mullen NL. Hip fracture mortality. A prospective, multifactorial study to predict and minimize death risk. Clin Orthop Relat Res. 1992(280):214–22.

    PubMed  Google Scholar 

  2. 2.

    Surin VV, Sundholm K. Survival of patients and prostheses after total hip arthroplasty. Clin Orthop Relat Res. 1983(177):148–53.

    PubMed  Google Scholar 

  3. 3.

    Taylor HD, Dennis DA, Crane HS. Relationship between mortality rates and hospital patient volume for Medicare patients undergoing major orthopaedic surgery of the hip, knee, spine, and femur. J Arthroplasty. 1997;12(3):235–42.

    PubMed  Article  CAS  Google 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(9):1291–4.

    PubMed  CAS  Google Scholar 

  5. 5.

    Fender D, Harper WM, Thompson JR, Gregg PJ. Mortality and fatal pulmonary embolism after primary total hip replacement. Results from a regional hip register. J Bone Joint Surg Br. 1997;79(6):896–9.

    PubMed  Article  CAS  Google Scholar 

  6. 6.

    Schoning B, Schulitz KP, Pfluger T. Statistical analysis of perioperative and postoperative mortality of patients with prosthetic replacement of the hip joint. Arch Orthop Trauma Surg. 1980;97(1):21–6.

    PubMed  Article  CAS  Google Scholar 

  7. 7.

    White RH, McCurdy SA, Marder RA. Early morbidity after total hip replacement: rheumatoid arthritis versus osteoarthritis. J Gen Intern Med. 1990;5(4):304–9.

    PubMed  Article  CAS  Google Scholar 

  8. 8.

    Memtsoudis SG, Della Valle AG, Besculides MC, Esposito M, Koulouvaris P, Salvati EA. Risk factors for perioperative mortality after lower extremity arthroplasty: a population-based study of 6,901,324 patient discharges. J Arthroplasty. 2010;25(1):19–26.

    PubMed  Article  Google Scholar 

  9. 9.

    Parvizi J, Ereth MH, Lewallen DG. Thirty-day mortality following hip arthroplasty for acute fracture. J Bone Joint Surg Am. 2004;86-A(9):1983–8.

    PubMed  Google Scholar 

  10. 10.

    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-A(10):1524–8.

    PubMed  CAS  Google Scholar 

  11. 11.

    Tsuboi M, Hasegawa Y, Suzuki S, Wingstrand H, Thorngren KG. Mortality and mobility after hip fracture in Japan: a ten-year follow-up. J Bone Joint Surg Br. 2007;89(4):461–6. doi:10.1302/0301-620X.89B4.18552

    PubMed  Article  CAS  Google Scholar 

  12. 12.

    Little JP. Consistency of ASA grading. Anaesthesia. 1995;50(7):658–9.

    PubMed  CAS  Google Scholar 

  13. 13.

    Salvati EA, Sharrock NE, Westrich G, Potter HG, Valle AG, Sculco TP. The 2007 ABJS Nicolas Andry Award: three decades of clinical, basic, and applied research on thromboembolic disease after THA: rationale and clinical results of a multimodal prophylaxis protocol. Clin Orthop Relat Res. 2007;459:246–54.

    PubMed  Article  Google Scholar 

  14. 14.

    Liu SS, Della Valle AG, Besculides MC, Gaber LK, Memtsoudis SG. Trends in mortality, complications, and demographics for primary hip arthroplasty in the United States. Int Orthop. 2009;33(3):643–51.

    PubMed  Article  Google Scholar 

  15. 15.

    Jensen JS, Holstein P. A long term follow-up of Moore arthroplasty in femoral neck fractures. Acta Orthop Scand. 1975;46(5):764–74.

    PubMed  Article  CAS  Google Scholar 

  16. 16.

    Lung HR. The role of prosthetic replacement of the head of the femur as primary treatment for subcapital fractures. Injury. 1971;3(2):107–13.

    PubMed  CAS  Google Scholar 

  17. 17.

    Visuri T, Pulkkinen P, Paavolainen P, Koskenvuo M, Turula KB. Causes of death after hip arthroplasty in primary arthrosis. J Arthroplasty. 1997;12(4):397–402.

    PubMed  Article  CAS  Google Scholar 

  18. 18.

    Orsini EC, Byrick RJ, Mullen JB, Kay JC, Waddell JP. Cardiopulmonary function and pulmonary microemboli during arthroplasty using cemented or non-cemented components. The role of intramedullary pressure. J Bone Joint Surg Am. 1987;69(6):822–32.

    PubMed  CAS  Google Scholar 

  19. 19.

    Breed AL. Experimental production of vascular hypotension, and bone marrow and fat embolism with methylmethacrylate cement. Traumatic hypertension of bone. Clin Orthop Relat Res. 1974(102):227–44.

    PubMed  Article  Google Scholar 

  20. 20.

    Wheelwright EF, Byrick RJ, Wigglesworth DF, Kay JC, Wong PY, Mullen JB et al. Hypotension during cemented arthroplasty. Relationship to cardiac output and fat embolism. J Bone Joint Surg Br. 1993;75(5):715–23.

    PubMed  CAS  Google Scholar 

  21. 21.

    Johnson R, Green JR, Charnley J. Pulmonary embolism and its prophylaxis following the Charnley total hip replacement. Clin Orthop Relat Res. 1977(127):123–32.

    PubMed  Google Scholar 

  22. 22.

    Shepherd A, Mills C. Fatal pulmonary embolism following hip and knee replacement. A study of 2153 cases using routine mechanical prophylaxis and selective chemoprophylaxis. Hip Int. 2006;16(1):53–6.

    PubMed  CAS  Google Scholar 

  23. 23.

    Howie C, Hughes H, Watts A. Venous thromboembolism associated with hip and knee replacement over a ten-year period: a population-based study. J Bone Joint Surg Br. 2005;87(12):1675–80.

    PubMed  Article  CAS  Google Scholar 

  24. 24.

    Freedman K, Brookenthal K, Fitzgerald RJ, Williams S, Lonner J. A meta-analysis of thromboembolic prophylaxis following elective total hip arthroplasty. J Bone Joint Surg Am. 2000;82(7):929–38.

    PubMed  Google Scholar 

  25. 25.

    Heit J, Elliott C, Trowbridge A, Morrey B, Gent M, Hirsh J. Ardeparin sodium for extended out-of-hospital prophylaxis against venous thromboembolism after total hip or knee replacement. A randomized, double-blind, placebo-controlled trial. Ann Intern Med. 2000;132(11):853–61.

    PubMed  CAS  Google Scholar 

  26. 26.

    Handschin AE, Trentz O, Kock HJ, Wanner GA. Low molecular weight heparin-induced skin necrosis—a systematic review. Langenbecks Arch Surg. 2005;390(3):249–54.

    PubMed  Article  CAS  Google Scholar 

  27. 27.

    Lilikakis AK, Papapolychroniou T, Macheras G, Michelinakis E. Thrombocytopenia and intra-cerebral complications associated with low-molecular-weight heparin treatment in patients undergoing total hip replacement. A report of two cases. J Bone Joint Surg Am. 2006;88(3):634–8.

    PubMed  Article  Google Scholar 

  28. 28.

    Sanchez-Ballester J, Smith M, Hassan K, Kershaw S, Elsworth CS, Jacobs L. Wound infection in the management of hip fractures: a comparison between low-molecular weight heparin and mechanical prophylaxis. Acta Orthop Belg. 2005;71(1):55–9.

    PubMed  Google Scholar 

  29. 29.

    Sharrock NE, Gonzalez Della Valle A, Go G, Lyman S, Salvati EA. Potent anticoagulants are associated with a higher all-cause mortality rate after hip and knee arthroplasty. Clin Orthop Relat Res. 2008;466(3):714–21.

    PubMed  Article  Google Scholar 

  30. 30.

    Murray DW, Britton AR, Bulstrode CJ. Thromboprophylaxis and death after total hip replacement. J Bone Joint Surg Br. 1996;78(6):863–70.

    PubMed  Article  CAS  Google Scholar 

  31. 31.

    Aynardi M, Pulido L, Parvizi J, Sharkey PF, Rothman RH. Early mortality after modern total hip arthroplasty. Clin Orthop Relat Res. 2009;467(1):213–8. doi:10.1007/s11999-008-0528-5.

    PubMed  Article  Google Scholar 

  32. 32.

    Moran CG, Wenn RT, Sikand M, Taylor AM. Early mortality after hip fracture: is delay before surgery important? J Bone Joint Surg Am. 2005;87(3):483–9.

    PubMed  Article  Google Scholar 

Download references


The authors wish to thank Silvana Figar, MD from the Department of Medical Informatics and Clinical Epidemiology, Hospital Italiano de Buenos Aires for her statistical analysis and kind collaboration.


Each author certifies that he or she has no commercial associations (e.g., consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article.

Each author certifies that his or her institution has approved the reporting of the case and that all investigations were conducted in conformity with the ethical principles of research.

Author information



Corresponding author

Correspondence to Fernando Comba MD.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Comba, F., Alonso Hidalgo, I., Buttaro, M. et al. Risk Factor Analysis for 30-Day Mortality After Primary THA in a Single Institution. HSS Jrnl 8, 111–115 (2012). https://doi.org/10.1007/s11420-012-9279-7

Download citation


  • mortality
  • total hip arthroplasty