title: Complications of Total Hip Arthroplasty: Standardized List, Definitions, and Stratification Developed by The Hip Society.
abstract: BACKGROUND
  Reporting of complications after total hip arthroplasty (THA) is not standardized, and it is done inconsistently across various studies on the topic. Advantages of standardizing complications include improved patient safety and outcomes and better reporting in comparative studies.
  
  
  OBJECTIVE
  The purpose of this project was to develop a standardized list of complications and adverse events associated with THA, develop standardized definitions for each complication, and stratify the complications. A further purpose was to validate these standardized THA complications.
  
  
  METHODS
  The Hip Society THA Complications Workgroup proposed a list of THA complications, definitions for each complication, and a stratification scheme for the complications. The stratification system was developed from a previously validated grading system for complications of hip preservation surgery. The proposed complications, definitions, and stratification were validated with an expert opinion survey of members of The Hip Society, a case study evaluation, and analysis of a large administrative hospital system database with a focus on readmissions.
  
  
  RESULTS
  One hundred five clinical members (100%) of The Hip Society responded to the THA complications survey. Initially, 21 THA complications were proposed. The validation process reduced the 21 proposed complications to 19 THA complications with definitions and stratification that were endorsed by The Hip Society (bleeding, wound complication, thromboembolic disease, neural deficit, vascular injury, dislocation/instability, periprosthetic fracture, abductor muscle disruption, deep periprosthetic joint infection, heterotopic ossification, bearing surface wear, osteolysis, implant loosening, cup-liner dissociation, implant fracture, reoperation, revision, readmission, death).
  
  
  CONCLUSIONS
  Acceptance and use of these standardized, stratified, and validated THA complications and adverse events could advance reporting of outcomes of THA and improve assessment of THA by clinical investigators.
  
  
  METHODS
  Level V, therapeutic study.
authors.affiliation: Kaplan Joint Center, Newton Wellesley Hospital, 2014 Washington Street, Newton, MA, 02462, USA. whealy@partners.org.|Massachusetts General Hospital, Boston, MA, USA. whealy@partners.org.
authors.forename: William L
authors.initials: WL
authors.lastname: Healy
authors.affiliation: NYU Langone Medical Center, New York, NY, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Iorio
authors.affiliation: NYU Langone Medical Center, New York, NY, USA.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Clair
authors.affiliation: Medical University of South Carolina, Charleston, SC, USA.
authors.forename: Vincent D
authors.initials: VD
authors.lastname: Pellegrini
authors.affiliation: Rush University Medical Center, Chicago, IL, USA.
authors.forename: Craig J
authors.initials: CJ
authors.lastname: Della Valle
authors.affiliation: Joint Implant Surgeons, New Albany, OH, USA.
authors.forename: Keith R
authors.initials: KR
authors.lastname: Berend
mesh_terms: D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D001696:Biomechanical Phenomena; D032921:Consensus; D016208:Databases, Factual; D006621:Hip Joint / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D010359:Patient Readmission; D011183:Postoperative Complications / Q000145:classification* / Q000175:diagnosis / Q000628:therapy; D012307:Risk Factors; D009626:Terminology as Topic; D016896:Treatment Outcome