Abstract
Background
Outcome and survival after primary total hip arthroplasty (THA) can be affected by
patient characteristics. We examined the effect of case-mix on revision after primary
THA using the Dutch Arthroplasty Register.
Methods
Our cohort included all primary THAs (n = 218,214) performed in patients with osteoarthritis
in the Netherlands between 2007 and 2018. Multivariable logistic regression analysis
was used to calculate the difference in survivorship in patients with different patient
characteristics (age, gender, American Society of Anesthesiologists [ASA] score, body
mass index [BMI], Charnley score, smoking, and previous operations to the hip).
Results
Case-mix factors associated with an increased risk for revision 1 year after THA were
the following: a high ASA score (II and III-IV) (odds ratio [OR] 1.5, 95% confidence
interval [CI] 1.1-2.0 and OR 3.0, 95% CI 1.7-5.3), a higher BMI (30-40 and >40) (OR
1.4, 95% CI 1.2-1.5 and OR 2.0, 95% CI 1.4-1.7), age ≥75 years (OR 1.5, 95% CI 1.1-2.0),
and male gender (OR 1.3, 95% CI 1.2-1.4). A similar model for 3-year revision showed
comparable results. High BMI (OR 1.9, 95% CI 1.3-2.9), a previous hip operation (OR
1.8, 95% CI 1.3-2.5), ASA III-IV (OR 1.2, 95% CI 1-1.6), and Charnley score C (OR
1.5, 95% CI 1.1-2.2) were associated with increased risk for revision. Main reasons
for revision in obese and ASA II-IV patients were infection, dislocation, and periprosthetic
fracture. Patients with femoral neck fracture and late post-traumatic pathology were
more likely to be revised within 3 years, compared to osteoarthritis patients (OR
1.5, 95% CI 1.3-1.7 and OR 1.5, 95% CI 1.2-1.7).
Conclusion
The short-term risk for revision after primary THA is influenced by case-mix factors.
ASA score and BMI (especially >40) were the strongest predictors for 1-year revision
after primary THA. After 3 years, BMI and previous hip surgery were independent risk
factors for revision. This will help surgeons to identify and counsel high-risk patients
and take appropriate preventive measures.
Keywords
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Article info
Publication history
Published online: August 14, 2019
Accepted:
August 8,
2019
Received in revised form:
July 27,
2019
Received:
March 12,
2019
Footnotes
Sources of Funding: R.M.P. and W.P.Z. received a grant (VRF2017-001) from the Van Rens Foundation, which was initiated by the Dutch Orthopedic Society (NOV), in order to perform this study.
Disclosure: None of the authors have any financial or personal relationships with other people or organizations that could potentially and inappropriately influence (bias) this work and its conclusions.
One or more of the authors of this paper have disclosed potential or pertinent conflicts of interest, which may include receipt of payment, either direct or indirect, institutional support, or association with an entity in the biomedical field which may be perceived to have potential conflict of interest with this work. For full disclosure statements refer to https://doi.org/10.1016/j.arth.2019.08.024.
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