Hip arthroplasty, changing trends in a national tertiary referral centre.

BACKGROUND

Despite changes in techniques and management, little has been published comparing hip replacement surgery over a three-decade time span.

AIMS

To document change in the practice of hip arthroplasty in a large elective orthopaedic centre.

METHODS

A retrospective analysis of 100 patients in 1979 and in 1999 comparing demographics, surgical approaches, blood loss, transfusion requirements, morbidity and length of stay.

RESULTS

In 1999, males predominated, spinal anaesthesia had largely superceded general anaesthesia, the anterolateral approach had replaced the trans-trochanteric approach, osteoarthritis remained the main aetiology and the Charnley prosthesis remained the implant of choice. Average blood loss was higher in 1999 compared to 1979 (1,378 vs 1,225 ml) but all patients in 1979 were transfused with an average of 2.8 units while in 1999 one-third of patients were transfused with an average of 1.6 units (p<0.0001). Length of stay had fallen from 30.5 days in 1979 to 16.2 days in 1999 (p<0.0001). Thromboembolic complications fell from 13% to 2% (p=0.0083).

CONCLUSION

The incidence of deep venous thrombosis (DVT), pulmonary embolus (PE) and length of hospital stay has fallen. Blood loss had changed little but fewer patients receive blood transfusion.