Epidemiology of total hip arthroplasty: demographics, comorbidities and outcomes

Abstract

Background Primary THA (THA) is a successful procedure for end-stage hip osteoarthritis. In the setting of a failed THA, revision total hip arthroplasty (rTHA) acts as a salvage procedure. This procedure has increased risks, including sepsis, infection, prolonged surgery time, blood loss, and increased length of stay. Increasing focus on understanding of demographics, comorbidities, and inpatient outcomes can lead to better perioperative optimization and post-operative outcomes. This epidemiological registry study aimed to compare the demographics, comorbidity profiles, and outcomes of patients undergoing THA and rTHA. Methods A retrospective review of discharge data reported from 2006 to the third quarter of 2015 using the National Inpatient Sample registry was performed. The study included adult patients aged 40 and older who underwent either THA or rTHA. A total of 2,838,742 THA patients and 400,974 rTHA patients were identified. Results The primary reimbursement for both THA and rTHA was dispensed by Medicare at 53.51% and 65.36% of cases respectively. Complications arose in 27.32% of THA and 39.46% of rTHA cases. Postoperative anemia was the most common complication in groups (25.20% and 35.69%). Common comorbidities in both groups were hypertension and chronic pulmonary disease. rTHA indications included dislocation/instability (21.85%) followed by mechanical loosening (19.74%), other mechanical complications (17.38%), and infection (15.10%). Conclusion Our data demonstrated a 69.50% increase in patients receiving THA and a 28.50% increase in rTHA from the years 2006 to 2014. The data demonstrated 27.32% and 39.46% complication rate with THA and rTHA, with postoperative anemia as the most common cause. Common comorbidities were hypertension and chronic pulmonary disease. Future analyses into preoperative optimizations, such as prior consultation with medical specialists or improved primary hip protocol, should be considered to prevent/reduce postoperative complications amongst a progressive expansion in patients receiving both THA and rTHA.

Short stem hip arthroplasty with the optimys prosthesis is a safe and effective option for obese patients: a mid-term follow-up multicenter study

“…Due to an aging society, the number of patients, who need a total hip arthroplasty (THA), increased considerably over the past years and is estimated to increase further in the future [ 1 – 3 ]. Furthermore, the proportion of patients, who require THA at younger age and at a more physically active stage of live, is growing [ 4 – 7 ].…”

Oral as compared to intravenous tranexamic acid to limit peri-operative blood loss associated with primary total hip arthroplasty

“…Total hip arthroplasty (THA) is associated with major bleeding and postoperative in-hospital anaemia occurs in approximatively 26% of cases. 1 Acute postoperative anaemia increases morbidity, mortality, length of stay and the frequency of heterologous blood transfusion. 2 Tranexamic acid (TXA) is an antifibrinolytic agent, widely used to reduce blood loss in THA.…”

A modified frailty index predicts complication, readmission, and 30-day mortality following the revision total hip arthroplasty

“…Centers for Disease Control and Prevention data show similar statistics with estimates of 86% of United States adults over 60 years having at least one chronic condition. Comorbidities such as congestive heart failure, diabetes, chronic pulmonary disease, and hypertension often lead to an increased risk of perioperative complications [ 13 ]. Beyond the issue of age are also specific comorbidities prudent in the consideration of more challenging surgeries like revision arthroplasties [ 14 , 15 ].…”