Lupus is associated with poorer outcomes after primary total hip arthroplasty

Objective The aim of this study was to assess whether lupus is associated with poorer outcomes after primary total hip arthroplasty (THA). Methods We used the 1998–2014 US National Inpatient Sample data. Multivariable-adjusted separate logistic regression models assessed the association of lupus with post-operative complications (implant infection, transfusion, THA revision and mortality) and health care utilization outcomes (total hospital charges, discharge to an inpatient facility and length of hospital stay >3 days) post-THA, adjusting for demographics, underlying diagnosis, comorbidity, insurance payer and hospital characteristics, using odds ratios (OR) and 95% confidence intervals (CI). Results Among 4,116,485 primary THA hospitalizations, 22,557 (0.5%) were in patients with lupus. Patients with lupus were younger and more likely to be female, African-American or Hispanic, living in the South, or to have Medicaid insurance, and had higher comorbidity or lower income. In multivariable-adjusted analyses, the presence of lupus was associated with significantly higher risk of implant infection, transfusion, discharge to an inpatient facility and higher hospital charges above the median, with respective ORs of 1.95 (95% CI, 1.28, 2.97), 1.34 (95% CI, 1.25, 1.43), 1.21 (95% CI, 1.01, 1.44) and 1.38 (95% CI, 1.30, 1.47). Lupus was not significantly associated with the risk of revision, mortality or hospital stay >3 days; the ORs were 1.10 (95% CI, 0.68, 1.78), 0.95 (95% CI, 0.61, 1.47) and 1.06 (95% CI, 0.99, 1.13), respectively. Conclusions Lupus was associated with a higher risk of implant infection, transfusion, discharge to an inpatient facility and higher hospital charges post-primary THA. Insight into modifiable factors associated with these outcomes may improve outcomes in patients with lupus undergoing THA.

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How Systemic Sclerosis Affects Healthcare Use and Complication Rates after Total Hip Arthroplasty

The Journal of Rheumatology ◽

10.3899/jrheum.190783 ◽

2019 ◽

Vol 47 (8) ◽

pp. 1218-1223 ◽

Cited By ~ 1

Author(s):

Jasvinder A. Singh ◽

John D. Cleveland

Keyword(s):

Systemic Sclerosis ◽

Total Hip Arthroplasty ◽

Hospital Stay ◽

Hip Arthroplasty ◽

The United States ◽

Hospital Charges ◽

Complication Rates ◽

Healthcare Use ◽

Implant Infection ◽

Total Hip

Objective.To assess whether outcomes after primary total hip arthroplasty (THA) differ in systemic sclerosis (SSc).Methods.We used the 1998–2014 US National Inpatient Sample. THA and SSc were identified using procedure and diagnostic codes, respectively. Multivariable-adjusted logistic regression analyses assessed the association of SSc with in-hospital complications (implant infection, revision, transfusion, mortality) post-THA and associated healthcare use (hospital charges, hospital stay, discharge to non-home setting), adjusting for age, sex, race, Deyo-Charlson comorbidity index, primary diagnosis for THA, household income, and insurance payer.Results.Of the 4,116,485 primary THA performed in the United States in 1998–2014, SSc patients made up 0.06% (n = 2672). In multivariable-adjusted analyses, compared to people without SSc, people with SSc had higher adjusted OR (95% CI) of the following post-primary THA: (1) non-home discharge, 1.25 (95% CI 1.03–1.50); (2) hospital stay > 3 days, 1.61 (95% CI 1.35–1.92); (3) transfusion, 1.54 (95% CI 1.28–1.84); and (4) in-hospital revision, 9.53 (95% CI 6.75–13.46). Differences in in-hospital mortality had a nonsignificant trend [2.19 (95% CI 0.99–4.86)]. There were no differences in total hospital charges or implant infection rates.Conclusion.SSc was associated with a higher rate of in-hospital complications and healthcare use after primary THA. Future studies should examine whether pre- or postoperative interventions can reduce the risk of post-THA complications in people with SSc.

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Comparison of short-term outcomes of anterolateral supine approach and posterolateral approach for primary total hip arthroplasty: a retrospective study

Journal of Orthopaedics and Traumatology ◽

10.1186/s10195-021-00570-2 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Taku Ukai ◽

Goro Ebihara ◽

Masahiko Watanabe

Keyword(s):

Total Hip Arthroplasty ◽

Hospital Stay ◽

Clinical Outcomes ◽

Hip Arthroplasty ◽

External Rotation ◽

Posterolateral Approach ◽

Level Of Evidence ◽

Total Hip ◽

Hip Flexion ◽

Primary Total Hip Arthroplasty

Abstract Background This study aims to evaluate postoperative pain and functional and clinical outcomes of anterolateral supine (ALS) and posterolateral (PL) approaches for primary total hip arthroplasty. Materials and methods We retrospectively examined the joints of 110 patients who underwent primary total hip arthroplasty (THA). The ALS group was compared with the PL group using the pain visual analog scale (VAS) and narcotic consumption as pain outcomes. Functional outcomes included postoperative range of motion (ROM) of hip flexion, day on which patients could perform straight leg raising (SLR), day on which patients began using a walker or cane, duration of hospital stay, rate of transfer, and strength of hip muscles. Clinical outcomes included pre and postoperative Harris Hip Scores. Results No significant differences were found in the pain VAS scores or narcotic consumption between the two groups. The PL group could perform SLR earlier than the ALS group (P < 0.01). The ALS group started using a cane earlier (P < 0.01) and had a shorter hospital stay (P < 0.01) than the PL group. Degrees of active ROM of flexion at postoperative day (POD) 1 were significantly lower in the ALS group than in the PL group (P < 0.01). Regarding hip muscle strength, hip flexion was significantly weaker in the ALS group than in the PL group until 1-month POD (P < 0.01). External rotation from 2 weeks to 6 months postoperatively was significantly weaker in the PL group than in the ALS group (P < 0.01). Conclusion The ALS approach was more beneficial than the PL approach because ALS enabled better functional recovery of the strength of external rotation, improved rehabilitation, and involved a shorter hospital stay. Level of Evidence Level IV retrospective observational study.

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