Comparison of mortality rate and septic and aseptic revisions in total hip arthroplasties for osteoarthritis and femoral neck fracture: an analysis of the German Arthroplasty Registry

Abstract

Background Indications for total hip arthroplasties (THA) differ from primary osteoarthritis (OA), which allows elective surgery through femoral neck fractures (FNF), which require timely surgical care. The aim of this investigation was to compare mortality and revisions in THA for primary OA and FNF. Methods Data collection for this study was performed using the German Arthroplasty Registry (EPRD) with analysis THA for the treatment of FNF and OA. Cases were matched 1:1 according to age, sex, body mass index (BMI), cementation, and the Elixhauser score using Mahalanobis distance matching. Results Overall 43,436 cases of THA for the treatment of OA and FNF were analyzed in this study. Mortality was significantly increased in FNF, with 12.6% after 1 year and 36.5% after 5 years compared with 3.0% and 18.7% in OA, respectively (p < 0.0001). The proportion for septic and aseptic revisions was significantly increased in FNF (p < 0.0001). Main causes for an aseptic failure were mechanical complications (OA: 1.1%; FNF: 2.4%; p < 0.0001) and periprosthetic fractures (OA: 0.2%; FNF: 0.4%; p = 0.021). As influencing factors for male patients with septic failure (p < 0.002), increased BMI and Elixhauser comorbidity score and diagnosis of fracture (all p < 0.0001) were identified. For aseptic revision surgeries, BMI, Elixhauser score, and FNF were influencing factors (p < 0.0001), while all cemented and hybrid cemented THA were associated with a risk reduction for aseptic failure within 90 days after surgery (p < 0.0001). Conclusion In femoral neck fractures treated with THA, a significant higher mortality, as well as septic and aseptic failure rate, was demonstrated compared with prosthesis for the therapy of osteoarthritis. Increased Elixhauser comorbidity score and BMI are the main influencing factors for development of septic or aseptic failure and can represent a potential approach for prevention measures. Level of evidence: Level III, Prognostic.

Difference in early all-cause mortality among patients having hip arthroplasty a Swedish perioperative registry study 2013–2022

“…This is similar to the osteoarthritis cohort in the present study (0.12%) [ 12 ], . Large differences in the one-year mortality between patients having undergone arthroplasty for either osteoarthritis or hip fracture were also observed in a recent German Arthroplasty-based study by Szymsky et al [ 17 ], 12.6% compared with 3% respectively.…”

“…There are also several recent studies that have assessed hip arthroplasty for the treatment of hip fractures. The crude mortality has in several of these studies showed a higher early mortality rate associated with cemented hip arthroplasty [ 13 – 17 ]. Studies have mostly focused on elderly patients.…”

Risk factors for liner wear and head migration in total hip arthroplasty: a systematic review

“…Different combinations of wear materials determine the different mechanical characteristics of the arthroplasty 17 – 19 . The harder the material, the lower the surface roughness and the lesser the vulnerability to deformation forces 20 – 22 . The diameter of the femoral head plays a crucial role in wear: small femoral heads present less wear consumption because friction is reduced while large femoral heads have greater stability and lower dislocation rate 23 , 24 .…”

Midterm survival and risk factor analysis in patients with pyogenic vertebral osteomyelitis: a retrospective study of 155 cases

“…In Germany the highest in-hospital mortality rate was recorded at 64.7 per 1,000 patients and intensive care unit (ICU) treatment was documented in 27.7% of cases (8). Intriguingly, in contrast to diagnoses such as major amputations, VO demonstrates comparatively lower mortality rates (10,11). The treatment of elderly patients, who are particularly vulnerable to these infections, is becoming increasingly important due to epidemiological development and the growing prevalence of comorbidities in an aging population (12).…”