Incidence rates of dislocation, pulmonary embolism, and deep infection during the first six months after elective total hip replacement.
BACKGROUND
The lengths of acute hospital stays following total hip replacement have diminished substantially in recent years. As a result, a greater proportion of complications occurs following discharge. Data on the incidence trends of major complications of total hip replacement would facilitate recognition and management of these adverse events.


METHODS
We used Medicare claims data on beneficiaries sixty-five years and older who had had elective, primary total hip replacement for a reason other than a fracture (58,521 patients) or had had revision total hip replacement (12,956 patients) between July 1, 1995, and June 30, 1996. We calculated incidence rates of dislocation, pulmonary embolism, and deep hip infection per 10,000 person-weeks for four time-periods following the admission for the surgery (during the index hospitalization, from discharge to four weeks postoperatively, from five to thirteen weeks postoperatively, and from fourteen to twenty-six weeks postoperatively). We then used life-table methods to estimate the cumulative incidence of each complication over the first six postoperative months.


RESULTS
Of the patients who had had a primary total hip replacement, 3.9% had a dislocation, 0.9% had a pulmonary embolism, and 0.2% had a deep infection in the first twenty-six postoperative weeks. In the revision total hip replacement cohort, the proportions with dislocation, pulmonary embolism, and deep infection were 14.4%, 0.8%, and 1.1%, respectively. The rates of these adverse outcomes were highest during the index hospitalization, diminished considerably in the period from discharge to four weeks postoperatively, and continued to drop in the periods from five to thirteen and fourteen to twenty-six weeks postoperatively.


CONCLUSIONS
The incidence rates of dislocation, pulmonary embolism, and deep infection are highest immediately after total hip replacement, but they continue to be elevated throughout the first three postoperative months. With the lengths of hospital stays continuing to diminish, an increasing proportion of complications will occur in outpatients. These findings provide a basis for developing strategies to prevent these complications in the postdischarge management of patients who have had elective total hip replacement.


METHODS
Prognostic study, Level II-1 (retrospective study). See p. 2 for complete description of levels of evidence.
Phillips
Charlotte B
CB
Robert Breck Brigham Multipurpose Arthritis and Musculoskeletal Diseases Center, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
Barrett
Jane A
JA
Losina
Elena
E
Mahomed
Nizar N
NN
Lingard
Elizabeth A
EA
Guadagnoli
Edward
E
Baron
John A
JA
Harris
William H
WH
Poss
Robert
R
Katz
Jeffrey N
JN
D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D015331:Cohort Studies; D017558:Elective Surgical Procedures / Q000009:adverse effects*; D005260:Female; D006617:Hip Dislocation / Q000453:epidemiology* / Q000209:etiology*; D006801:Humans; D015994:Incidence; D007592:Joint Diseases / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011655:Pulmonary Embolism / Q000453:epidemiology* / Q000209:etiology*; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000209:etiology*; D013997:Time Factors