ASA class is associated with early revision and reoperation after total hip arthroplasty: an analysis of the Geneva and Swedish Hip Arthroplasty Registries

Predicting reoperation and readmission for head and neck free flap patients using machine learning

BACKGROUND

To develop machine learning (ML) models predicting unplanned readmission and reoperation among patients undergoing free flap reconstruction for head and neck (HN) surgery.

METHODS

Data were extracted from the 2012-2019 NSQIP database. eXtreme Gradient Boosting (XGBoost) was used to develop ML models predicting 30-day readmission and reoperation based on demographic and perioperative factors. Models were validated using 2019 data and evaluated.

RESULTS

Four-hundred and sixty-six (10.7%) of 4333 included patients were readmitted within 30 days of initial surgery. The ML model demonstrated 82% accuracy, 63% sensitivity, 85% specificity, and AUC of 0.78. Nine-hundred and four (18.3%) of 4931 patients underwent reoperation within 30 days of index surgery. The ML model demonstrated 62% accuracy, 51% sensitivity, 64% specificity, and AUC of 0.58.

CONCLUSION

XGBoost was used to predict 30-day readmission and reoperation for HN free flap patients. Findings may be used to assist clinicians and patients in shared decision-making and improve data collection in future database iterations.

Global mapping of institutional and hospital-based (Level II-IV) arthroplasty registries: a scoping review

PURPOSE

Four joint arthroplasty registries (JARs) levels exist based on the recorded data type. Level I JARs are national registries that record primary data. Hospital or institutional JARs (Level II-IV) document further data (patient-reported outcomes, demographic, radiographic). A worldwide list of Level II-IV JARs must be created to effectively assess and categorize these data.

METHODS

Our study is a systematic scoping review that followed the PRISMA guidelines and included 648 studies. Based on their publications, the study aimed to map the existing Level II-IV JARs worldwide. The secondary aim was to record their lifetime, publications' number and frequency and recognise differences with national JARs.

RESULTS

One hundred five Level II-IV JARs were identified. Forty-eight hospital-based, 45 institutional, and 12 regional JARs. Fifty JARs were found in America, 39 in Europe, nine in Asia, six in Oceania and one in Africa. They have published 485 cohorts, 91 case-series, 49 case-control, nine cross-sectional studies, eight registry protocols and six randomized trials. Most cohort studies were retrospective. Twenty-three per cent of papers studied patient-reported outcomes, 21.45% surgical complications, 13.73% postoperative clinical and 5.25% radiographic outcomes, and 11.88% were survival analyses. Forty-four JARs have published only one paper. Level I JARs primarily publish implant revision risk annual reports, while Level IV JARs collect comprehensive data to conduct retrospective cohort studies.

CONCLUSIONS

This is the first study mapping all Level II-IV JARs worldwide. Most JARs are found in Europe and America, reporting on retrospective cohorts, but only a few report on studies systematically.

Multimorbidity measured with Charlson Comorbidity Index is not associated with clinically relevant risk of revision after primary total hip arthroplasty: a population-based cohort study on 98,647 patients from the Danish Hip Arthroplasty Register

BACKGROUND AND PURPOSE

Evidence for guiding healthcare professionals on the risks of total hip arthroplasty (THA) in multimorbid patients is sparse. We aimed to examine the association between multimorbidity and the risk of revision due to any cause and specific causes after primary THA due to osteoarthritis.

PATIENTS AND METHODS

We identified 98,647 THA patients and subsequent revisions in the Danish Hip Arthroplasty Register from 1995 to 2018. Multimorbidity was measured with the Charlson Comorbidity Index (CCI). Using the CCI (low, medium, high), we calculated the cumulative incidence function (CIF) of first revision up to 10 years after THA. Adjusted cause-specific hazard ratios (aHRs) were estimated using Cox regressions. All estimates are presented with 95% confidence intervals (CI).

RESULTS

Overall, the prevalence of patients with low, medium, and high CCI was 70%, 24%, and 6%. The CIF of any revision within 10 years was 6.5% (CI 6.2-6.7) in low and 6.5% (CI 5.8-7.3) in high CCI, with an aHR of 1.4 (CI 1.2-1.6) for patients with high compared with low CCI. The corresponding aHRs for cause-specific revision were 1.3 (CI 1.0-1.6) for aseptic loosening within 10 years, 1.2 (CI 0.9-1.6) for infection, and 1.7 (CI 1.3-2.2) for dislocation, both within 2 years.

CONCLUSION

Multimorbidity is associated with a minor but not clinically relevant increased risk of revision up to 10 years after primary THA.

Risk Factors for Failure of Total Ankle Replacements: A Data Linkage Study Using the National Joint Registry and NHS Digital

BACKGROUND

Despite the increasing numbers of ankle replacements, there remains debate about which patients should undergo an ankle replacement, and there are limited studies analyzing risk factors for failure of an ankle replacement. The primary aim of this study is to analyze the risk factors for failure of total ankle replacements.

METHODS

A data linkage study combining the National Joint Registry (NJR) Data and NHS (National Health Service) Digital data was performed. The primary outcome of failure is defined as the removal or exchange of any components of the implanted device. Kaplan-Meier survival charts were used to illustrate survivorship. Multivariable Cox proportional hazards regression models were fitted to analyze potential risk factors for failures or ankle replacements.

RESULTS

The overall 5-year survival was 90.2% (95% CI 89.2%-91.1%). In multivariable (adjusted) Cox regression models, only age (hazard ratio [HR] 0.96, 95% CI 0.94-0.97), body mass index (BMI; HR 1.03, 95% CI 1.01-1.06), and underlying etiology (HR 0.88, 95% CI 0.80-0.97) were associated with an increased risk of failure.

CONCLUSION

This study demonstrates that younger patients and those with an increased BMI have an increased risk of failure of a primary ankle replacement. We also show that rheumatoid patients have higher survivorship than those with osteoarthritis.

LEVEL OF EVIDENCE

Level III, retrospective cohort study.

Risk Factors for 30-Day Unplanned Re-Operation in Pediatric Upper Extremity Surgery: A National Surgical Quality Improvement Program (NSQIP)-Pediatric Analysis

Introduction The unplanned re-operation rate has been used as one marker of procedure quality in numerous surgical sub-fields. The purpose of this study was to determine independent risk factors for unplanned re-operations within 30 days following pediatric upper extremity surgery. Methods Pediatric patients who had a primary upper extremity procedure from 2012 to 2019 were identified in the National Surgical Quality Improvement Program-Pediatric database. The procedures included percutaneous fixation of supracondylar humerus fractures, open treatment of humeral condylar fractures, tendon sheath incision, repair of syndactyly, and reconstruction of polydactyly. Patients were categorized by those who had unplanned return to the operating room within 30 days and patients who did not. Patient demographics, clinical characteristics, and medical co-morbidities were evaluated for their association with re-operation using bivariate and multivariate analysis. Results A total of 27,536 pediatric patients underwent primary upper extremity surgeries; of these, 290 (1.1%) required an unplanned re-operation. After controlling for potential confounding variables on multivariable regression analysis, American Society of Anesthesiologists (ASA) class III-V (OR 15.89; p<0.001), inpatient procedure (OR 1.29; p=0.044), emergent/urgent triage (OR 3.75; p<0.001), longer operative time (OR 1.01; p<0.001), and prolonged hospital stay (OR 1.01; p=0.010) were independent predictors for re-operation. Conclusion This study demonstrates that the national rate of 30-day unplanned re-operation in pediatric upper extremity surgeries is low overall. The greatest risk factors for unplanned re-operation were ASA class III-V, inpatient setting, emergent/urgent triage, longer operative time, and prolonged hospital stay. This knowledge can help further improve patient outcomes through risk stratification and preoperative planning.

UK poSt Arthroplasty Follow-up rEcommendations (UK SAFE): what does analysis of linked, routinely collected national data sets tell us about mid-late term revision risk after hip replacement? Retrospective cohort study

OBJECTIVE

To identify patients at risk of mid-late term revision of hip replacement to inform targeted follow-up.

DESIGN

Analysis of linked national data sets from primary and secondary care (Clinical Practice Research Datalink (CPRD-GOLD); National Joint Registry (NJR); English Hospital Episode Statistics (HES); Patient-Reported Outcome Measures (PROMs)).

PARTICIPANTS

Primary elective total hip replacement (THR) aged≥18.

EVENT OF INTEREST

Revision surgery≥5 years (mid-late term) after primary THR.

STATISTICAL METHODS

Cox regression modelling to ascertain risk factors of mid-late term revision. HR and 95% CI assessed association of sociodemographic factors, comorbidities, medication, surgical variables and PROMs with mid-late term revision.

RESULTS

NJR-HES-PROMs data were available from 2008 to 2011 on 142 275 THR; mean age 70.0 years and 61.9% female. CPRD GOLD-HES data covered 1995-2011 on 17 047 THR; mean age 68.4 years, 61.8% female. Patients had minimum 5 years postprimary surgery to end 2016. In NJR-HES-PROMS data, there were 3582 (2.5%) revisions, median time-to-revision after primary surgery 1.9 years (range 0.01-8.7), with 598 (0.4%) mid-late term revisions; in CPRD GOLD, 982 (5.8%) revisions, median time-to-revision 5.3 years (range 0-20), with 520 (3.1%) mid-late term revisions.Reduced risk of mid-late term revision was associated with older age at primary surgery (HR: 0.96; 95% CI: 0.95 to 0.96); better 6-month postoperative pain/function scores (HR: 0.35; 95% CI: 0.27 to 0.46); use of ceramic-on-ceramic (HR: 0.73; 95% CI: 0.56 to 0.95) or ceramic-on-polyethylene (HR: 0.76; 95% CI: 0.58 to 1.00) bearing surfaces.Increased risk of mid-late term revision was associated with the use of antidepressants (HR: 1.32; 95% CI: 1.09 to 1.59), glucocorticoid injections (HR: 1.33; 95% CI: 1.06 to 1.67) and femoral head size≥44 mm (HR: 2.56; 95% CI: 1.09 to 6.02)No association of gender, obesity or Index of Multiple Deprivation was observed.

CONCLUSION

The risk of mid-late term THR is associated with age at primary surgery, 6-month postoperative pain and function and implant factors. Further work is needed to explore the associations with prescription medications observed in our data.

The lifetime risk of revision following total knee arthroplasty : a New Zealand Joint Registry study

AIMS

The success of total knee arthroplasty (TKA) is usually measured using functional outcome scores and revision-free survivorship. However, reporting the lifetime risk of revision may be more meaningful to patients when gauging risks, especially in younger patients. We aimed to assess the lifetime risk of revision for patients in different age categories at the time of undergoing primary TKA.

METHODS

The New Zealand Joint Registry database was used to obtain revision rates, mortality, and the indications for revision for all primary TKAs performed during an 18-year period between January 1999 and December 2016. Patients were stratified into age groups at the time of the initial TKA, and the lifetime risk of revision was calculated according to age, sex, and the American Society of Anesthesiologists (ASA) grade. The most common indications for revision were also analyzed for each age group.

RESULTS

The overall ten-year survival rate was 95.6%. This was lowest in the youngest age group (between 46 and 50 years) and increased sequentially with increasing age. The lifetime risk of requiring revision was 22.4% in those aged between 46 and 50 years at the time of the initial surgery, and decreased linearly with increasing age to 1.15% in those aged between 90 and 95 years at the time of surgery. Higher ASA grades were associated with increased lifetime risk of revision in all age groups. The three commonest indications for revision were aseptic loosening, infection, and unexplained pain. Young males, aged between 46 and 50 years, had the highest lifetime risk of revision (25.2%).

CONCLUSION

Lifetime risk of revision may be a more meaningful measure of outcome than implant survival at defined time periods when counselling patients prior to TKA. This study highlights the considerably higher lifetime risk of revision surgery for all indications, including infection, in younger male patients. Cite this article: Bone Joint J 2022;104-B(2):235-241.

Revision Risk in a Cohort of US Patients Younger Than 55 Undergoing Primary Elective Total Hip Arthroplasty

BACKGROUND

As indications for elective total hip arthroplasty (THA) expand to younger patients, we sought to (1) compare revision risk following primary elective THA in patients <55 years at the time of their THA to patients aged ≥65 years and (2) identify specific risk factors for revision in patients <55 years.

METHODS

A Kaiser Permanente's total joint replacement registry was used to conduct a cohort study including primary elective THA patients aged ≥18 (2001-2018). In total, 11,671 patients <55 years and 53,106 patients ≥65 years were included. Multiple Cox regression was used to evaluate cause-specific revision risk, including septic revision, aseptic loosening, instability, and periprosthetic fracture. Stepwise Cox regression was used to identify patient and surgical factors associated with cause-specific revision in patients <55 years.

RESULTS

Patients <55 years had a higher risk of septic revision (hazard ratio [HR] = 1.30, 95% confidence interval [CI] = 1.02-1.66), aseptic loosening (HR = 2.60, 95% CI = 1.99-3.40), and instability (HR = 1.35, 95% CI = 1.09-1.68), but a lower risk of revision for periprosthetic fracture (HR = 0.36, 95% CI = 0.22-0.59) compared to patients aged ≥65 years. In the <55 age group, risk factors for septic revision included higher body mass index, drug abuse, and liver disease. Hypertension, anterior approach, and ceramic-on-ceramic were associated with aseptic loosening. White race, American Society of Anesthesiologists classification ≥3, smoker, paralysis, posterior approach, ceramic-on-ceramic, and smaller head diameter were associated with instability.

CONCLUSION

Identified risk factors varied depending on the cause for revision. Although septic revisions were related to patient characteristics, more modifiable factors, such as implant or surgical approach, were associated with revision due to aseptic loosening and instability.

LEVEL OF EVIDENCE

III.

Worse patient-reported outcomes and higher risk of reoperation and adverse events after total hip replacement in patients with opioid use in the year before surgery: a Swedish register-based study on 80,483 patients

Background and purpose - Recent studies indicate that preoperative use of opioids could be associated with higher rates of complications and worse patient-reported outcomes (PROs) after orthopedic surgery. We investigated the prevalence of preoperative opioid use and analyzed its influence on risk of revision, adverse events (AE), and PROs in patients with total hip replacement (THR). Patients and methods - This observational study included 80,483 patients operated on in 2008-2016 with THRs due to osteoarthritis. Data was obtained from the Swedish Hip Arthroplasty Register, Statistics Sweden's sociodemographic registers, the Swedish National Patient Register, and the Prescribed Drug Register. We focused on patients with ≥ 4 opioid prescriptions filled 1 year prior to THR. To control for confounding, we used propensity scores to weight subjects in our analyses. Logistic and linear regression was used for outcome variables with adjustments for sociodemographic variables and comorbidities. Results - Patients with ≥ 4 opioid prescriptions in the year before THR (n = 14,720 [18%]) had a higher risk of revision within 2 years (1.8% vs. 1.1% OR 1.4, 95% CI 1.3-1.6) and AE within 90 days (9.4% vs. 6.4% OR 1.2, 95% CI 1.2-1.3) compared with patients without opioid treatment in the preoperative period. Patients with ≥ 4 opioid prescriptions rated 5 points worse on a 0-100 scale of Pain Visual Analogue Scale (VAS) and 9 points worse on a general health (EQ) VAS 1 year postoperatively. Interpretation - Having ≥ 4 opioid prescriptions filled in the year before surgery is associated with a higher risk of revision, adverse events, and worse PROs after THR. Consequently, preoperative opioid treatment should be addressed in the clinical assessment of patients eligible for THR.

Comorbidity indices in orthopaedic surgery: a narrative review focused on hip and knee arthroplasty

Comorbidity indices currently used to estimate negative postoperative outcomes in orthopaedic surgery were originally developed among non-orthopaedic patient populations.

While current indices were initially intended to predict short-term mortality, they have since been used for other purposes as well.

As the rate of hip and knee arthroplasty steadily rises, understanding the magnitude of the effect of comorbid disease on postoperative outcomes has become increasingly more important.

Currently, the ASA classification is the most commonly used comorbidity measure and is systematically recorded by the majority of national arthroplasty registries.

Consideration should be given to developing an updated, standardized approach for comorbidity assessment and reporting in orthopaedic surgery, especially within the setting of elective hip and knee arthroplasty.

Cite this article: EFORT Open Rev 2021;6:629-640. DOI: 10.1302/2058-5241.6.200124

Does pre-existing morbidity influences risks and benefits of total hip replacement for osteoarthritis: a prospective study of 6682 patients from linked national datasets in England

Total hip arthroplasty (THA) surgery for elderly people with multimorbidity increases the risk of serious health hazards including mortality. Whether such background morbidity reduces the clinical benefit is less clear.

OBJECTIVE

To evaluate how pre-existing health status, using multiple approaches, influences risks of, and quality of life benefits from, THA.

SETTING

Longitudinal record linkage study of a UK sample linking their primary care to their secondary care records.

PARTICIPANTS

A total of 6682 patients were included, based on the recording of the diagnosis of hip osteoarthritis in a national primary care register and the recording of the receipt of THA in a national secondary care register.Data were extracted from the primary care register on background health and morbidity status using five different constructs: Charlson Comorbidity Index, Electronic Frailty Index (eFI) and counts of comorbidity disorders (from list of 17), prescribed medications and number of primary care visits prior to recording of THA.

OUTCOME MEASURES

(1) Postoperative complications and mortality; (2) postoperative hip pain and function using the Oxford Hip Score (OHS) and health-related quality of life using the EuroQoL (EQ)-5D score.

RESULTS

Perioperative complication rate was 3.2% and mortality was 0.9%, both increased with worse preoperative health status although this relationship varied depending on the morbidity construct: the eFI showing the strongest relationship but number of visits having no predictive value. By contrast, the benefits were not reduced in those with worse preoperative health, and improvement in both OHS and EQ-5D was observed in all the morbidity categories.

CONCLUSIONS

Independent of preoperative morbidity, THA leads to similar substantial improvements in quality of life. These are offset by an increase in medical complications in some subgroups of patients with high morbidity, depending on the definition used. For most elderly people, their other health disorders should not be a barrier for THA.

The Update on Instruments Used for Evaluation of Comorbidities in Total Hip Arthroplasty

INTRODUCTION

It is a well-established fact that concomitant diseases can affect the outcome of total hip arthroplasty (THA). Therefore, careful preoperative assessment of a patient's comorbidity burden is a necessity, and it should be a part of routine screening as THA is associated with a significant number of complications. To measure the multimorbidity, dedicated clinical tools are used.

METHODS

The article is a systematic review of instruments used to evaluate comorbidities in THA studies. To create a list of available instruments for assessing patient's comorbidities, the search of medical databases (PubMed, Web of Science, Embase) for indices with proven impact on revision risk, adverse events, mortality, or patient's physical functioning was performed by two independent researchers.

RESULTS

The initial search led to identifying 564 articles from which 26 were included in this review. The measurement tools used were: The Charlson Comorbidity Index (18/26), Society of Anesthesiology classification (10/26), Elixhauser Comorbidity Method (6/26), and modified Frailty Index (5/26). The following outcomes were measured: quality of life and physical function (8/26), complications (10/26), mortality (8/26), length of stay (6/26), readmission (5/26), reoperation (2/26), satisfaction (2/26), blood transfusion (2/26), surgery delay or cancelation (1/26), cost of care (1/26), risk of falls (1/26), and use of painkillers (1/26). Further research resulted in a comprehensive list of eleven indices suitable for use in THA outcomes studies.

CONCLUSION

The comorbidity assessment tools used in THA studies present a high heterogeneity level, and there is no particular system that has been uniformly adopted. This review can serve as a help and an essential guide for researchers in the field.

[Quality criteria in arthroplasty]

The discipline of orthopedics and trauma surgery strives for constant improvement of the quality of results in arthroplasty; however, in order to enable targeted alterations to the establish standard operating procedures, dedicated documentation of the current quality of results is necessary. This can be achieved by so-called external quality assurance, evaluation of routine data of healthcare providers, analysis of clinical studies and the consultation of registry data. To achieve further improvement of the quality of results, legislature has been passed setting requirements for minimum quantities and by the specialist society (German Society for Orthopedics and Orthopedic Surgery, DGOOC) the adherence to certain process and structural guidelines within the framework of the certification system EndoCert®. A valid score for risk adjustment for assessment of the level of difficulty of orthopedic surgical interventions is so far lacking. As a future direction, the application of risk stratification concerning patient-specific anatomy should be developed. Through the combination of dedicated certification systems, the recording and evaluation of external inpatient quality assurance data, further quality assurance through routinely collected data and the development of adequate minimum quantity regulations, sustainable improvement of the quality of results can be achieved.

The lifetime risk of revision following total hip arthroplasty

AIMS

Joint registries typically use revision of an implant as an endpoint and report survival rates after a defined number of years. However, reporting lifetime risk of revision may be more meaningful, especially in younger patients. We aimed to assess lifetime risk of revision for patients in defined age groups at the time of primary surgery.

METHODS

The New Zealand Joint Registry (NZJR) was used to obtain rates and causes of revision for all primary total hip arthroplasties (THAs) performed between January 1999 and December 2016. The NZJR is linked to the New Zealand Registry of Births, Deaths and Marriages to obtain complete and accurate data. Patients were stratified by age at primary surgery, and lifetime risk of revision calculated according to age, sex, and American Society of Anesthesiologists (ASA) classification. The most common causes for revision were also analyzed for each age group.

RESULTS

The overall, ten-year implant survival rate was 93.6% (95% confidence interval (CI) 93.4% to 93.8%). It was lowest in the youngest age group (46 to 50 years), rising sequentially with increasing age to 97.5% in the oldest group (90 to 95 years). Lifetime risk of revision surgery was 27.6% (95% CI 27.3% to 27.8%) in those aged 46 to 50 years, decreasing with age to 1.1% (95% CI 0.0% to 5.8%) in those aged 90 to 95 years at the time of primary surgery. Higher ASA grades were associated with an increased lifetime risk of revision across all ages. The commonest causes for revision THA were aseptic loosening, infection, periprosthetic fracture, and dislocation.

CONCLUSION

When counselling patients preoperatively, the lifetime risk of revision may be a more meaningful and useful measure of longer-term outcome than implant survival at defined time periods. This study highlights the considerably increased likelihood of subsequent revision surgery in younger age groups. Cite this article: Bone Joint J 2021;103-B(3):479-485.

Total Hip Arthroplasty Revision Surgery: Impact of Morbidity on Perioperative Outcomes

BACKGROUND

Primary and revision total hip arthroplasty (THA) is increasingly performed in patients with high comorbidity burden. Its predominantly negative effects on outcomes are well understood in primary THA; however, the effects of morbidity on revision THA are unknown. Since revision procedures account for about 10% of the total surgical volume, we set out to investigate the effects of physical health status on perioperative outcomes in this setting.

METHODS

We queried our prospectively collected institutional database for patients who underwent revision THA at our institution (Orthopedic University Hospital Friedrichsheim, Frankfurt) between 2007 and 2011. Patients were classified according to American Society of Anesthesiologists (ASA) category and number of comorbidities. Subsequently, their impact on perioperative parameters was analyzed.

RESULTS

Our database revealed 294 cases of revision THA during the study period. Patients preoperatively classified as ASA 3 and 4 showed significantly higher rates of intraoperative and postoperative complications, transfusions, prolonged intensive care unit (ICU) stay, and total length of stay (LOS) compared to patients classified as ASA 1 and 2. Similarly, patients with >3 comorbidities presented with significantly elevated postoperative complications, ICU stay, and LOS. Particularly, preoperative cardiac diseases were associated with increased blood loss, transfusions, duration of surgery, postoperative complications, ICU stay, LOS, and re-revisions.

CONCLUSION

Poor physical health condition is associated with negative perioperative outcomes in revision THA. Especially cardiac comorbidities are linked to unfavorable outcomes, which have important implications for assessment of perioperative risk.

Preoperative Risk Prediction Models for Short-Term Revision and Death After Total Hip Arthroplasty: Data from the Finnish Arthroplasty Register

Because of the increasing number of total hip arthroplasties (THAs), even a small proportion of complications after the operation can lead to substantial individual difficulties and health-care costs. The aim of this study was to develop simple-to-use risk prediction models to assess the risk of the most common reasons for implant failure to facilitate clinical decision-making and to ensure long-term survival of primary THAs.

Fast track protocol for primary total hip arthroplasty in non-trauma cases reduces the length of hospital stay: Prospective French multicenter study

BACKGROUND

Fast-track (FT) procedures continue to evolve; however, their benefits are still controversial. This led us to conduct a prospective study of FT procedures for total hip arthroplasty (THA) on a national scale in France with historical control data. The aims were to (1) evaluate the effectiveness of FT procedures after THA on the length of hospital stay (LOS) in a multicenter analysis, (2) measure the immediate return to home, rehospitalization and reoperation rates.

HYPOTHESIS

FT procedures reduce the LOS after primary THA for non-traumatic indications relative to national historical data.

METHODS

A prospective observational study was done at 11 hospital facilities throughout France. Patients who underwent primary THA for a non-traumatic condition and FT procedures were followed for 3 months. The average LOS, discharge to home, unexpected readmissions, and reoperation rate were compared to 2016 figures from the French national database of 104,745 procedures on the same population.

RESULTS

The study included 1,110 patients, 499 men (45%) and 611 women (55%), with a mean age of 67.5±11.9 years. The average LOS was 3.3±2.9 days versus 7.5±5.3 days in the national database (p<0.001). Eight hundred eighty patients (79%) were discharged directly to home versus 72,577 (69%) in the national database (p<0.001). Forty-two patients (4%) were readmitted to the hospital within 90 days of the THA versus 11,092 (11%) in the national database (p<0.001). Eighteen patients (1.6%) were reoperated within 90 days of the THA procedure versus 2100 (2.0%) in the national database (p=0.72).

DISCUSSION

FT procedures help to significantly reduce the average LOS and rehospitalization rate after primary THA for non-traumatic conditions and significantly increased the percentage of patients being discharged directly to home relative to national historical data, without altering the risk of reoperation. FT procedures should become the standard of care after THA.

LEVEL OF EVIDENCE

III; prospective case-control study.

Mortality as a competition risk factor in the survival analysis of the results of the type of fixation of the total hip prosthesis in octogenarian patients

INTRODUCTION

Total hip replacement (THR) is challenging in octogenarians due to associated comorbidities and controversy regarding fixation type. We ask whether cemented THR is superior to uncemented THR in patients above the age of 80 years.

MATERIAL AND METHODS

A total of 382 patients (441 hips) aged 80 years or older who underwent THR between 2004 and 2015 were analysed. A cemented THR was implanted in 196 hips (group 1), an uncemented THR with a grit-blasted stem in 121 (group 2), or with a porous-coated stem in 124 (group 3). Patients in group 1 had a higher mean age, more comorbidities and osteoporotic bone. Survival analysis was calculated using cumulative incidence function to account for the competing risk of death.

RESULTS

Medical complications rate was similar. There were 3post-operative fractures: one in group 2 and 2in group 3. Competing risk analysis showed that the cumulative incidence of revision for any cause was 2.3 in group 1, 6.0 in group 2 and 4.1 in group 3 at 10years, and the cumulative incidence of revision for aseptic loosening was 1.2 in group 1, 3.7 in group 2 and 0 in group 3 at the same period.

CONCLUSIONS

THR presents an acceptable number of adverse events for octogenarian patients. Despite uncemented fixation was satisfactory, the higher peri-prosthetic fracture rate worsens results in this group.