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Hip dislocations after 2,734 elective unilateral fast-track total hip arthroplasties: incidence, circumstances and predisposing factors

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@article{f8b837964266403bb133f8bea112a5ce,
title = "Hip dislocations after 2,734 elective unilateral fast-track total hip arthroplasties: incidence, circumstances and predisposing factors",
abstract = "STUDY DESIGN: Retrospective review of prospectively collected data.OBJECTIVE: To investigate the incidence of hip dislocation 90 days after total hip arthroplasty in relation to time after surgery, mechanism of dislocation and predisposing factors.METHODS: Prospective data on preoperative patient characteristics from six Danish arthroplasty departments with similar fast-track approaches were cross-referenced with the Danish National Patient Registry for complete 90-day follow-up on readmissions, including emergency-room contacts. Complete patient files and postoperative radiographs were reviewed in case of dislocations. Unadjusted comparisons were made using t test/Chi-square analyses, while evaluation of risk factors potentially predisposing to dislocations was done using uni- and multivariate regression analysis.RESULTS: A total of 2,734 consecutive unselected procedures were available for analysis, of which 65 (2.4 {\%}) had dislocations. Of these, eight were during index admission and five were treated and discharged from the emergency room. Mechanisms of dislocation were most often movement while supine or sitting for the first 30 days and due to squatting/bending from day 31 to 90. The 65 patients with dislocations had suboptimal cup placement in 34 (52.3 {\%}), and a femoral head size of <36 mm in 20 (30.8 {\%}) cases. Predisposing factors of dislocation were age ≥75 [OR:1.96 (1.18-3.38)], pharmacologically treated psychiatric disease [OR:2.37 (1.29-4.36)] and department of surgery [OR:2.27 (1.31-3.40)] but not hospital stay of <4 days. Departments with recommendations for activity restrictions had fewer dislocations than a department without restrictions.CONCLUSIONS: Patients ≥75 years and with pharmacologically treated psychiatric disease may be at increased risk of dislocations after fast-track total hip arthroplasty. Further studies including detailed information on patient and prosthesis characteristics, and activity restrictions are needed to reduce the risk of dislocation.",
author = "J{\o}rgensen, {Christoffer C} and Per Kjaersgaard-Andersen and S{\o}ren Solgaard and Henrik Kehlet",
year = "2014",
doi = "10.1007/s00402-014-2051-3",
language = "English",
volume = "134",
pages = "1615--1622",
journal = "Archiv fur orthopadische und Unfall-Chirurgie",
issn = "0003-9330",
publisher = "Springer",
number = "11",

}

RIS

TY - JOUR

T1 - Hip dislocations after 2,734 elective unilateral fast-track total hip arthroplasties

T2 - incidence, circumstances and predisposing factors

AU - Jørgensen, Christoffer C

AU - Kjaersgaard-Andersen, Per

AU - Solgaard, Søren

AU - Kehlet, Henrik

PY - 2014

Y1 - 2014

N2 - STUDY DESIGN: Retrospective review of prospectively collected data.OBJECTIVE: To investigate the incidence of hip dislocation 90 days after total hip arthroplasty in relation to time after surgery, mechanism of dislocation and predisposing factors.METHODS: Prospective data on preoperative patient characteristics from six Danish arthroplasty departments with similar fast-track approaches were cross-referenced with the Danish National Patient Registry for complete 90-day follow-up on readmissions, including emergency-room contacts. Complete patient files and postoperative radiographs were reviewed in case of dislocations. Unadjusted comparisons were made using t test/Chi-square analyses, while evaluation of risk factors potentially predisposing to dislocations was done using uni- and multivariate regression analysis.RESULTS: A total of 2,734 consecutive unselected procedures were available for analysis, of which 65 (2.4 %) had dislocations. Of these, eight were during index admission and five were treated and discharged from the emergency room. Mechanisms of dislocation were most often movement while supine or sitting for the first 30 days and due to squatting/bending from day 31 to 90. The 65 patients with dislocations had suboptimal cup placement in 34 (52.3 %), and a femoral head size of <36 mm in 20 (30.8 %) cases. Predisposing factors of dislocation were age ≥75 [OR:1.96 (1.18-3.38)], pharmacologically treated psychiatric disease [OR:2.37 (1.29-4.36)] and department of surgery [OR:2.27 (1.31-3.40)] but not hospital stay of <4 days. Departments with recommendations for activity restrictions had fewer dislocations than a department without restrictions.CONCLUSIONS: Patients ≥75 years and with pharmacologically treated psychiatric disease may be at increased risk of dislocations after fast-track total hip arthroplasty. Further studies including detailed information on patient and prosthesis characteristics, and activity restrictions are needed to reduce the risk of dislocation.

AB - STUDY DESIGN: Retrospective review of prospectively collected data.OBJECTIVE: To investigate the incidence of hip dislocation 90 days after total hip arthroplasty in relation to time after surgery, mechanism of dislocation and predisposing factors.METHODS: Prospective data on preoperative patient characteristics from six Danish arthroplasty departments with similar fast-track approaches were cross-referenced with the Danish National Patient Registry for complete 90-day follow-up on readmissions, including emergency-room contacts. Complete patient files and postoperative radiographs were reviewed in case of dislocations. Unadjusted comparisons were made using t test/Chi-square analyses, while evaluation of risk factors potentially predisposing to dislocations was done using uni- and multivariate regression analysis.RESULTS: A total of 2,734 consecutive unselected procedures were available for analysis, of which 65 (2.4 %) had dislocations. Of these, eight were during index admission and five were treated and discharged from the emergency room. Mechanisms of dislocation were most often movement while supine or sitting for the first 30 days and due to squatting/bending from day 31 to 90. The 65 patients with dislocations had suboptimal cup placement in 34 (52.3 %), and a femoral head size of <36 mm in 20 (30.8 %) cases. Predisposing factors of dislocation were age ≥75 [OR:1.96 (1.18-3.38)], pharmacologically treated psychiatric disease [OR:2.37 (1.29-4.36)] and department of surgery [OR:2.27 (1.31-3.40)] but not hospital stay of <4 days. Departments with recommendations for activity restrictions had fewer dislocations than a department without restrictions.CONCLUSIONS: Patients ≥75 years and with pharmacologically treated psychiatric disease may be at increased risk of dislocations after fast-track total hip arthroplasty. Further studies including detailed information on patient and prosthesis characteristics, and activity restrictions are needed to reduce the risk of dislocation.

U2 - 10.1007/s00402-014-2051-3

DO - 10.1007/s00402-014-2051-3

M3 - Journal article

VL - 134

SP - 1615

EP - 1622

JO - Archiv fur orthopadische und Unfall-Chirurgie

JF - Archiv fur orthopadische und Unfall-Chirurgie

SN - 0003-9330

IS - 11

ER -

ID: 44483614