Inflammatory Arthritis Is a Risk Factor for Multiple Complications After Total Hip Arthroplasty: A Population-Based Comparative Study of 68,348 Patients |
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| Institution: | 1. Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH;2. Department of Orthopaedic Surgery, Detroit Medical Center, Detroit, MI;3. Department of Orthopaedic Surgery, Cleveland Clinic Florida, Weston, FL;1. Board Member-At-Large, American Association of Hip and Knee Surgeons University of Virginia, USA;2. Member, Hip Society, Rush University Medical Center, USA;3. Member, Knee Society, Stanford University, USA;4. President, American Association of Hip and Knee Surgeons Rush University Medical Center, USA;1. Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY;2. Department of Mechanical and Aerospace Engineering, NYU Tandon School of Engineering, Brooklyn, NY;3. Department of Mechanical Engineering, Edificio de Rectorado, Universidad de La Rioja, Logroño, La Rioja, Spain;4. Department of Biomedical Engineering, NYU Tandon School of Engineering, Brooklyn, NY;5. Department of Clinical Development, OrthoSensor Inc, Dania Beach, FL;6. Department of Human Structure and Repair, Ghent University, Ghent, Belgium;1. Department of Surgery, Yale School of Medicine, New Haven, CT;2. Department of Orthopaedics & Rehabilitation, Yale School of Medicine, New Haven, CT;3. Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Harvard T.H. Chan School of Public Health, Boston, MA;4. Division of Geriatrics, Department of Internal Medicine, Yale School of Medicine, New Haven, CT;5. Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI |
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| Abstract: | BackgroundPatients with inflammatory arthritis (IA) are likely at higher risk of postoperative complications following total hip arthroplasty (THA), from the underlying disease, the degree of articular deformity, and immunosuppressive medications. The purpose of this study was to perform a comparative study of the risk of complications after THA between IA and osteoarthritis.MethodsA national private insurance database was used to select patients undergoing unilateral primary THA. Patients were categorized to the inflammatory cohort if they had a diagnosis of IA and treatment with an IA-specific medication within the year before surgery. Patients with no diagnosis of IA were considered osteoarthritis. Risk of Centers for Medicare and Medicaid Services–reportable complications and 90-day readmission was compared between cohorts using multivariate logistic regression controlling for age, gender, length of stay, comorbidities, and corticosteroid use.ResultsA total of 68,348 patients were included; 2.12% met criteria for IA. Patients with IA were found to have higher risk of transfusion (odds ratio OR], 1.29; P < .01), mechanical complications (OR, 1.35; P = .01), infection (OR, 1.96; P < .01), and 90-day readmission (OR, 1.35; P < .01). There were no differences in risk of venous thromboembolism or medical complications.ConclusionPatients with IA have significantly higher risk of transfusion, mechanical complications, infection, and readmission following THA. Efforts should be made to optimize their health and medications before THA to minimize their complication risk. Additionally, hospitals should receive commensurate resources to maintain access to THA for patients with IA who are prone to higher resource utilization.Level of EvidenceIII. |
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| Keywords: | total hip arthroplasty inflammatory arthritis osteoarthritis complications readmission infection |
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