[Predictive factors of perioperative morbidity in revision total hip arthroplasty].
OBJECTIVE
The awareness and prevention of perioperative morbidity are essential in revision total hip arthroplasty [THA]. Therefore, it was the purpose of this study to assess the rate of perioperative complications following revision THA in order to evaluate the impact of patient- and procedure-related variables.


METHODS
169 consecutive patients with a mean age of 71.7 years suffering from aseptic loosening of their THA were included in this retrospective study. Multivariate logistic regression models with estimation of the odds ratio [OR] and 95% confidence interval [CI] served to analyze the influence of operation duration, gender, revision status, ASA classification, and type of fixation of the primary implant on the perioperative morbidity.


RESULTS
68.6% of the cases were primary revisions, and 31.4% secondary or multiple revisions. 49.7% of the operations involved exchange of the complete implant whereas 39.1% comprised exchange of the cup and 11.2% exchange of the stem only. Mean operation duration was 130 minutes [min] (range: 40-260 min), and mean intraoperative blood loss was 2.6 L (0.5 to 12 L). The rate of intraoperative complications was 10.1 % with a 6.5 % fracture rate. Postoperatively the complication rate was 25.4% with an 8.3% rate of luxations. 11.8% of the patients had revision within the first three weeks after surgery. Regression models showed the significant impact of revision status (primary vs. secondary or multiple: OR 2.90, 95% CI 1.42-5.92) and operation duration (per min starting from the mean operation time: OR 1.01, 95% CI 1.00-1.02) on the resulting complication rate. Analysis of the perioperative complication rate following primary revisions revealed a significant difference (p = 0.03) between patients with cemented (15/36, 41.7%) and non-cemented (8/45, 17.8%) implants.


CONCLUSIONS
Revision status with a three-fold increase in patients with multiple revisions as well as operation duration with a 1 % increase per min starting from the mean operation time significantly influence the perioperative morbidity. Patients with a first revision, furthermore, seem to be at greater risk for an adverse event perioperatively if their implant is fully cemented. These findings should be taken into account prior to initiating surgery.
Kinkel
S
S
Stiftung Orthopädische Universitätsklinik Heidelberg, Abteilung Orthopädie I, Heidelberg, Germany.
Kessler
S
S
Mattes
T
T
Reichel
H
H
Käfer
W
W
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000401:mortality*; D016063:Blood Loss, Surgical / Q000503:physiopathology; D001843:Bone Cements / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D005858:Germany; D006801:Humans; D007431:Intraoperative Complications / Q000401:mortality / Q000601:surgery; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000401:mortality* / Q000601:surgery*; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors
D001843:Bone Cements