Elsevier

Journal of Arthroscopy and Joint Surgery

Volume 7, Issue 4, October–December 2020, Pages 172-176
Journal of Arthroscopy and Joint Surgery

Research paper
Mortality and other complications after revision joint arthroplasty: Investigating the modifiable independent predictors

https://doi.org/10.1016/j.jajs.2020.09.009Get rights and content

Abstract

Objective

The aim of this study was to determine the mortality rate and other complications after revision total joint arthroplasites (TJAs) during the first year of follow-up and to identify the patient-related risk factors predicting mortality, major and minor complications and prolonged hospital stay.

Methods

The hospital’s database program was used to identify patients who had undergone revision hip arthroplasty (114 patients) or revision knee arthroplasty (87 patients) between the years 2013 and 2018. Patients’ demographics and perioperative data were collected.Relationships between the perioperative factors and the outcomes were tested using univariable analysis. Significant variables were analyzed using a multivariate logistic regression model.

Results

The mortality rates during the first year of follow-up of RHA and RKA patients were 7% and 3.3%, respectively (p = 0.356). The rates of major complications in RHA and RKA patients were 13.2% and 6.9% (p = 0.150) and the rates of minor complications were 14.9% and 11.5%, respectively (p = 0.481). The mean length of hospital stay was 9.8 ± 11.8 days for RHA patients and 8.3 ± 10 days for RKA patients (p = 0.002). Being over the age of 80, having undergone septic revisions and having an ASA score greater than 2 were independent risk factors for mortality and major complications during the first year of follow-up. Blood transfusion, a BMI greater than 30 and re-revision surgery were independent predictors for minor complications and prolonged length of stay at the hospital.

Conclusion

Being over the age of 80, having undergone septic revisions and having an ASA score greater than 2 were independent risk factors for mortality and major complications during the first year of follow-up. Blood replacement, a BMI greater than 30 and re-revision surgery were independent predictors for minor complications and prolonged length of stay at the hospital. Blood transfusion is the important modifiable independent predictor for complications and prolonged hospital stay after revision TJAs.

Introduction

The rapid increase in the number of primary joint arthroplasty in the last decade causes the number of revision joint arthroplasty to increase gradually. In a future projection study conducted in the United States, it is predicted that between 2005 and 2030, primary total hip arthroplastics will increase by 174% and primary total knee arthroplasties by 673%. In the same study, it was shown that the number of revision hip arthroplasty will increase by 137% and revision knee arthroplasty by 601%.1,2

Revision arthroplasties have a relatively high rate of mortality and major complications. In a regional United States study, analyzed 4953 primary total hip arthoplasty(THA), 10,163 primary total knee arthroplasty(TKA), 496 revision hip arthoplasty (RHA) and 606 revision knee arthoplasty (RKA), show that one year mortality rates are 1,1% for THA, 0,9% for TKA, 2,2% for RHA, 4,3 for RKA %.3

Choi et al.4 reported that mortality rates after revision hip arthroplasty were 33% in the septic group and 22% in the aseptic group during their 5–6 years of follow-up. In another study Choi and Bedair,5 the authors reported that mortality rates after revision knee arthroplasty were 18% in the septic group and 3% in the aseptic group after four years of follow-up. Badarudeen et al.6 showed that mortality rates after RHA was 2,2% in 3555 patients during their 1 year of follow-up. Yao et al.7 reported that 10 years mortality rates after RKA were 47% in the septic group, 46% in the fracture group, 34% in the aseptic loosening group.

Considering that revision arthroplasty numbers are increasing rapidly and mortality and complications are common, approved metrics are needed for risk classification in this patient population to potentially alleviate these events.8 Determination of predictors on mortality, complications and length of hospital stay after revision TJAs can provide medical optimization by making better preoperative preparation. It may also provide patients to be better informed on the basis of evidence and reduce the cost.9

The aim of this study was to determine the mortality rate and other complications after revision total joint arthroplasites (TJAs) during the first year of follow-up and to identify the patient-related risk factors predicting mortality, complications and prolonged hospital stay.

Section snippets

Data collection

An analysis of the hospital software program database between 2013 and 2019 was performed. Social Security Institution Healthcare Practice Communique codes were used to identify all patients who had revision hip or knee arthroplasties for all causes. Analysis results identified 201 patients. All patients were included in the study because the data of all patients were available.

A variety of demographics and preoperative characteristics including age, sex, the American Society of

Results

A total of 201 patients were included in the study. Those who had undergone RHA accounted for 56.7% (114) of the patients (septic:20.2% (23); aseptic: 79.8% (91)), while the remaining 43.3% (87) had undergone RKA (septic: 33.3%(29), aseptic: 66.7% (58)) (Table 1). The mortality rate during the first year of follow up was 3.3% (3/91) in the aseptic hip group, 21.7% (5/23) in the septic hip group, 1.7% (1/58) in the aseptic knee group and 6.9% (2/29) in the septic knee group (Table 1).

Discussion

The data from the US National Hospital Discharge Survey shows that the total number of revision procedures almost doubled for revision hip arthroplasties and tripled for revision knee arthroplasties from 1990 to 2002.1 Patients who underwent revision arthroplasty are more prone to complications, of which periprosthetic joint infection and mortality are the most devastating.13,14 Compared with other surgical procedures the in-hospital mortality rate of septic revision THA was higher than for

Conclusion

Revision arthroplasties have a relatively high rate of mortality and major complications. If we had the ability to predict which patients would have postoperative complications, we could decrease the mortality and complication rates. In addition, we could inform the patients about the evidence-based risks of revision TJAs. For this reason, preoperative examination and preparation should be performed carefully and revision surgeries should be performed in centers experienced in critical care.22

Credit author statement

Mustafa Kavak : InvestigatioN , Methodology, Writing - Original Draft, Kerem Başarır: Conceptualization, Methodology, Sancar Alp Ovalı: Investigation, Formal analysis, Anar Keremov: Writing- Reviewing and Editing.

References (22)

  • Sameer Badarudeen et al.

    Complications after revision total hip arthroplasty in the medicare population

    J Arthroplasty

    (2017)
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