The Journal of Bone and Joint Surgery (American) 85:20-26 (2003)
© 2003 The Journal of Bone and Joint Surgery, Inc.
Incidence Rates of Dislocation, Pulmonary Embolism, and Deep Infection During the First Six Months After Elective Total Hip Replacement
Charlotte B. Phillips, RN, MPH,
Jane A. Barrett, MSc,
Elena Losina, PhD,
Nizar N. Mahomed, MD, ScD, FRCSC,
Elizabeth A. Lingard, BPhty, MPhil, MPH,
Edward Guadagnoli, PhD,
John A. Baron, MD, MSc,
William H. Harris, MD,
Robert Poss, MD and
Jeffrey N. Katz, MD, MS
Investigation performed at Brigham and Women's Hospital, Boston, Massachusetts, and Dartmouth Medical Center, Hanover, New Hampshire
Charlotte B. Phillips, RN, MPH
Elizabeth A. Lingard, BPhty, MPhil, MPH
Robert Poss, MD
Jeffrey N. Katz, MD, MS
Robert Breck Brigham Multipurpose Arthritis and Musculoskeletal Diseases Center (C.B.P., J.N.K., and E.L.), Division of Rheumatology, Immunology and Allergy (J.N.K.), and Department of Orthopaedic Surgery (E.A.L. and R.P.), Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115. E-mail address for J.N. Katz: jnkatz{at}partners.org
Jane A. Barrett, MSc
John A. Baron, MD, MSc
Department of Community and Family Medicine, Dartmouth Medical Center, Hanover, NH 03755
Elena Losina, PhD
Department of Epidemiology and Biostatistics, Boston University School of Public Health, 715 Albany Street, Boston, MA 02118
Nizar N. Mahomed, MD, ScD, FRCSC
Toronto Western Hospital, 399 Bathurst Street, ECW 1-002, Toronto, ON M5T 2S8, Canada
Edward Guadagnoli, PhD
Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115
William H. Harris, MD
Department of Orthopaedics, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114
In support of their research or preparation of this manuscript, one or more of the authors received National Institutes of Health Grants P60 AR36308, P60 AR47782, and K24 AR02123 and a Clinical Science Grant from the Arthritis Foundation. None of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. A commercial entity (Stryker) paid or directed, or agreed to pay or direct, benefits to a research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.
Background: The lengths of acute hospital stays following total hip replacement have diminished substantially in recent years. As a result, a greater proportion of complications occurs following discharge. Data on the incidence trends of major complications of total hip replacement would facilitate recognition and management of these adverse events.
Methods: We used Medicare claims data on beneficiaries sixty-five years and older who had had elective, primary total hip replacement for a reason other than a fracture (58,521 patients) or had had revision total hip replacement (12,956 patients) between July 1, 1995, and June 30, 1996. We calculated incidence rates of dislocation, pulmonary embolism, and deep hip infection per 10,000 person-weeks for four time-periods following the admission for the surgery (during the index hospitalization, from discharge to four weeks postoperatively, from five to thirteen weeks postoperatively, and from fourteen to twenty-six weeks postoperatively). We then used life-table methods to estimate the cumulative incidence of each complication over the first six postoperative months.
Results: Of the patients who had had a primary total hip replacement, 3.9% had a dislocation, 0.9% had a pulmonary embolism, and 0.2% had a deep infection in the first twenty-six postoperative weeks. In the revision total hip replacement cohort, the proportions with dislocation, pulmonary embolism, and deep infection were 14.4%, 0.8%, and 1.1%, respectively. The rates of these adverse outcomes were highest during the index hospitalization, diminished considerably in the period from discharge to four weeks postoperatively, and continued to drop in the periods from five to thirteen and fourteen to twenty-six weeks postoperatively.
Conclusions: The incidence rates of dislocation, pulmonary embolism, and deep infection are highest immediately after total hip replacement, but they continue to be elevated throughout the first three postoperative months. With the lengths of hospital stays continuing to diminish, an increasing proportion of complications will occur in outpatients. These findings provide a basis for developing strategies to prevent these complications in the postdischarge management of patients who have had elective total hip replacement.
Level of Evidence: Prognostic study, Level II-1 (retrospective study). See p. 2 for complete description of levels of evidence.
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