Risk of further surgery on the same or opposite side and mortality after primary total hip arthroplasty: A multi-state analysis of 133,654 patients from the Swedish Hip Arthroplasty Register

Cnudde, Peter; Nemes, Szilárd; Bülow, Erik; Timperley, A. John; Whitehouse, Sarah L.; Kärrholm, Johan; Rolfson, Ola

doi:10.1080/17453674.2018.1475179

Cited by 14 publications

(9 citation statements)

References 38 publications

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“…A previous study of our research group has described the effect of both comorbidity and socioeconomic status on both mortality and revision after THR (Cnudde et al. 2018c). We are aware that the indication at the time of primary surgery probably influences the reason for subsequent revisions with those who have a THR for complications after trauma or acute fracture having a higher risk of dislocation, periprosthetic fracture, and infection (Cnudde et al.…”

Section: Discussionmentioning

confidence: 98%

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Association between patient survival following reoperation after total hip replacement and the reason for reoperation: an analysis of 9,926 patients in the Swedish Hip Arthroplasty Register

et al. 2019

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Background and purpose — The association between long-term patient survival and elective primary total hip replacement (THR) has been described extensively. The long-term survival following reoperation of THR is less well understood. We investigated the relative survival of patients undergoing reoperation following elective THR and explored an association between the indication for the reoperation and relative survival. Patients and methods — In this observational cohort study we selected the patients who received an elective primary THR and subsequent reoperations during 1999–2017 as recorded in the Swedish Hip Arthroplasty Register. The selected cohort was followed until the end of the study period, censoring or death. The indications for 1st- and eventual 2nd-time reoperations were analyzed and the relative survival ratio of the observed survival and the expected survival was determined. Results — There were 9,926 1st-time reoperations and of these 2,558 underwent further reoperations. At 5 years after the latest reoperation, relative survival following 1st-time reoperations was 0.94% (95% CI 0.93–0.96) and 0.90% (CI 0.87–0.92) following 2nd-time reoperations. At 5 years patients with a 1st-time reoperation for aseptic loosening had higher survival than expected; however, reoperations performed for periprosthetic fracture, dislocation, and infection had lower survival. Interpretation — The relative survival following 1st- and 2nd-time reoperations in elective THR patients differs by reason for reoperation. The impact of reoperation on life expectancy is more obvious for infection/dislocation and periprosthetic fracture.

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Section: Discussionmentioning

confidence: 98%

“…We are aware that the indication at the time of primary surgery probably influences the reason for subsequent revisions with those who have a THR for complications after trauma or acute fracture having a higher risk of dislocation, periprosthetic fracture, and infection (Cnudde et al. 2018c).…”

Section: Discussionmentioning

confidence: 99%

Association between patient survival following reoperation after total hip replacement and the reason for reoperation: an analysis of 9,926 patients in the Swedish Hip Arthroplasty Register

et al. 2019

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“… 5 Some recent data suggest that multiple surgeries, especially on the same surgical site, increase the risk of perioperative complications, all of which may explain the increased risk of PJI in the staged cohort compared with the concurrent removal cohort. 8 Regardless, these findings have important implications for the treating surgeon of a patient with pre-existing hardware in their hip, especially as no homogeneous literature exists supporting staged or concurrent hardware removal in conjunction with THA. This study serves as an important landmark for surgeons to draw upon to make evidence-based decisions regarding these at-risk patients in the preoperative period.…”

Section: Discussionmentioning

confidence: 99%

Decreased Risk of Periprosthetic Joint Infection with Concurrent Hardware Removal During Conversion Total Hip Arthroplasty Compared to Staged Removal: A Matched Cohort Analysis

Sequeira,

Hasenauer,

McKinstry

et al. 2023

JAAOS Glob Res Rev

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Introduction: Hardware removal before conversion total hip arthroplasty (cTHA) is a challenging task for the orthopaedic surgeon, although there is little consensus on the timing of hardware removal to mitigate risk of surgery-related complication following cTHA. Methods: Using a national insurance database, we evaluated patients who underwent hardware removal either on the same day or within 1 year before cTHA, resulting in a total of 7,756 patients. After matching based on demographic factors and comorbidities, both staged and concurrent groups consisted of 2,752 patients. The 90-day and 1-year risk of revision surgery, periprosthetic joint infection (PJI), periprosthetic fracture, and aseptic loosening were calculated and compared. Demographic factors and comorbidities were further evaluated as risk factors for PJI. Results: The rates of infection were 1.85% and 3.05% at 90 days postoperatively and 2.94% and 4.14% at 1 year postoperatively for concurrent versus staged cohorts, respectively (P = 0.004 and P = 0.02). No difference was observed at 90 days or 1 year between the two cohorts in risk of fracture, revision surgery, or aseptic loosening. Diabetes (P = 0.002 and P < 0.001), tobacco use (P < 0.001 and P < 0.001), and obesity (P = 0.026 and P = 0.025) were identified as risk factors for PJI at both 90 days and 1 year postoperatively. Discussion: The timing of hardware removal is associated with an increased risk of PJI, although no difference was observed in revision surgery, fracture, or loosening among staged versus concurrent cohorts. These findings are important to consider when surgeons are evaluating patients with periarticular implants surrounding their hip.

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“…In addition, we performed stratified sensitivity analyses for method of fixation (uncemented, all-cemented), hybrid (uncemented cup, cemented stem), and reverse hybrid (cemented cup, uncemented stem) to assess the impact of changes over time in type of fixation. Because we did not have data on comorbidity, we performed stratified analyses on age groups (< 55, 55–75, and >75 years), as a surrogate measure of comorbidity and frailty [ 16 ].…”

Section: Methodsmentioning

confidence: 99%

Increasing risk of revision due to infection after primary total hip arthroplasty: results from the Nordic Arthroplasty Register Association

Dale

Fenstad

Hallan

et al. 2023

ActaO

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Background and purpose: The incidence of periprosthetic joint infection after total hip arthroplasty (THA) may be increasing. We performed time-trend analyses of risk, rates, and timing of revision due to infection after primary THAs in the Nordic countries from the period 2004–2018.Patients and methods: 569,463 primary THAs reported to the Nordic Arthroplasty Register Association from 2004 to 2018 were studied. Absolute risk estimates were calculated by Kaplan–Meier and cumulative incidence function methods, whereas adjusted hazard ratios (aHR) were assessed by Cox regression with the first revision due to infection after primary THA as primary endpoint. In addition, we explored changes in the time span from primary THA to revision due to infection.Results: 5,653 (1.0%) primary THAs were revised due to infection during a median follow-up time of 5.4 (IQR 2.5–8.9) years after surgery. Compared with the period 2004–2008, the aHRs for revision were 1.4 (95% confidence interval [CI] 1.3–1.5) for 2009–2013, and 1.9 (CI 1.7–2.0) for 2014–2018. The absolute 5-year rates of revision due to infection were 0.7% (CI 0.7–0.7), 1.0% (CI 0.9–1.0), and 1.2% (CI 1.2–1.3) for the 3 time periods respectively. We found changes in the time span from primary THA to revision due to infection. Compared with 2004–2008, the aHR for revision within 30 days after THA was 2.5 (CI 2.1–2.9) for 2009–2013, and 3.4 (CI 3.0–3.9) for 2013–2018. The aHR for revision within 31–90 days after THA was 1.5 (CI 1.3–1.9) for 2009–2013, and 2.5 (CI 2.1–3.0) for 2013–2018, compared with 2004–2008.Conclusion: The risk of revision due to infection after primary THA almost doubled, both in absolute cumulative incidence and in relative risk, throughout the period 2004–2018. This increase was mainly due to an increased risk of revision within 90 days of THA. This may reflect a “true” increase (i.e., frailer patients or more use of uncemented implants) and/or an “apparent” increase (i.e., improved diagnostics, changed revision strategy, or completeness of reporting) in incidence of periprosthetic joint infection. It is not possible to disclose such changes in the present study, and this warrants further research.

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Risk of further surgery on the same or opposite side and mortality after primary total hip arthroplasty: A multi-state analysis of 133,654 patients from the Swedish Hip Arthroplasty Register

Cited by 14 publications

References 38 publications

Association between patient survival following reoperation after total hip replacement and the reason for reoperation: an analysis of 9,926 patients in the Swedish Hip Arthroplasty Register

Association between patient survival following reoperation after total hip replacement and the reason for reoperation: an analysis of 9,926 patients in the Swedish Hip Arthroplasty Register

Decreased Risk of Periprosthetic Joint Infection with Concurrent Hardware Removal During Conversion Total Hip Arthroplasty Compared to Staged Removal: A Matched Cohort Analysis

Increasing risk of revision due to infection after primary total hip arthroplasty: results from the Nordic Arthroplasty Register Association

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