Primary and Revision Total Hip Arthroplasty in Patients With Pulmonary Hypertension: High Perioperative Mortality and Medical Complications |
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| Institution: | 1. Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota;2. Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota;1. Department of Orthopaedic Surgery, ENDO-Klinik Hamburg, Hamburg, Germany;2. Department of Orthopaedic Surgery and Traumatology, Centro Hospitalar Universitário do Porto, Porto, Portugal;1. Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio;2. Department of Orthopedic Surgery, Duke University Medical Center, Durham, North Carolina;3. Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina;4. Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland;1. Department of Medical Biophysics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada;2. Department of Surgery, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada;3. Imaging Group, Robarts Research Institute, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada;1. Department of Orthopaedic Surgery, Rush University, Chicago, Illinois;2. Department of Orthopedic Surgery, Columbia University, New York, New York;3. Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania |
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| Abstract: | BackgroundPerioperative medical management during total hip arthroplasty (THA) is continuously improving, allowing an increasing number of medically complex patients to undergo total joint arthroplasty. This study examined mortalities, medical complications, implant survivorships, and clinical outcomes of THA in patients who have pulmonary hypertension (HTN).MethodsWe identified 638 patients who had pulmonary HTN and underwent 508 primary THAs and 191 revision THAs from 2000 to 2016 at a tertiary care center. Patients were followed up at regular intervals until death, revision surgery, or last clinical follow-up. Perioperative medical complications were individually reviewed. The risk of death was examined by calculating standardized mortality ratios and Cox proportional hazards regression models. Cumulative incidence analyses were used for reporting mortality, reoperation, and revision with death as a competing risk.ResultsThe 90-day mortality was 1.8% and 3.1% for primary and revision THAs, respectively. The risk of death was approximately two-fold higher compared to primary (hazard ratio 2.69) and revision (hazard ratio 2.04) THA patients who did not have pulmonary HTN. Rate of medical complications within 90 days from surgery were 6.2% and 13.1% in primary and revision THAs, respectively. The 10-year cumulative incidence of any revision was 9% and 14% following primaries and revisions, respectively.ConclusionPatients who had pulmonary HTN undergoing primary and revision THAs had an increased risk of death and experienced a high rate of medical complications within 90 days of surgery. Counseling of risks, medical optimization, and referral to medical centers expert at managing complex medical problems should be considered.Level of EvidenceLevel IV. |
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| Keywords: | total hip arthroplasty revision total hip arthroplasty pulmonary hypertension complications mortality |
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