Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA.
School of Medicine, University of California, San Francisco, San Francisco, California, USA.
Bone Joint J. 2019 Jun;101-B(6_Supple_B):77-83. doi: 10.1302/0301-620X.101B6.BJJ-2018-1488.R1.
Increasingly, patients with bilateral hip arthritis wish to undergo staged total hip arthroplasty (THA). With the rise in demand for arthroplasty, perioperative risk assessment and counselling is crucial for shared decision making. However, it is unknown if complications that occur after a unilateral hip arthroplasty predict complications following surgery of the contralateral hip.
We used nationwide linked discharge data from the Healthcare Cost and Utilization Project between 2005 and 2014 to analyze the incidence and recurrence of complications following the first- and second-stage operations in staged bilateral total hip arthroplasty (BTHAs). Complications included perioperative medical adverse events within 30 to 60 days, and infection and mechanical complications within one year. Conditional probabilities and odds ratios (ORs) were calculated to determine whether experiencing a complication after the first stage of surgery increased the risk of developing the same complication after the second stage.
A total of 13 829 patients (5790 men and 8039 women) who underwent staged BTHAs were analyzed. The mean age at first operation was 62.9 years (14 to 95). For eight of the 12 outcomes evaluated, patients who experienced the outcome following the first arthroplasty had a significantly increased probability and odds of developing that same complication following the second arthroplasty, compared with those who did not experience the complication after the first surgery. This was true for digestive complications (OR 25.67, 95% confidence interval (CI) 13.86 to 46.08; p < 0.001), urinary complications (OR 6.48, 95% CI 1.7 to 20.73; p = 0.01), haematoma (OR 12.17, 95% CI 4.55 to 31.14; p < 0.001), deep vein thrombosis (OR 4.82, 95% CI 2.34 to 9.65; p < 0.001), pulmonary embolism (OR 12.03, 95% CI 2.02 to 46.77; p = 0.01), deep hip infection (OR 534.21, 95% CI 314.96 to 909.25; p < 0.001), superficial hip infection (OR 1574.99, 95% CI 269.83 to 9291.81; p < 0.001), and mechanical malfunction (OR 117.49, 95% CI 91.55 to 150.34; p < 0.001).
The occurrence of certain complications after unilateral THA is associated with an increased risk of the same complication occurring after staged arthroplasty of the contralateral hip. Patients who experience these complications after unilateral hip arthroplasty should be appropriately counselled regarding their risk profile prior to undergoing staged contralateral hip arthroplasty. Cite this article: 2019;101-B(6 Supple B):77-83.
越来越多双侧髋关节炎患者希望接受分期全髋关节置换术（THA）。随着对关节置换术需求的增加，围手术期风险评估和咨询对于共同决策至关重要。但是，尚不清楚单侧髋关节置换术后发生的并发症是否会预测对侧髋关节手术后的并发症。
我们使用了医疗保健成本和利用项目（HCUP）在 2005 年至 2014 年之间的全国性出院数据，分析分期双侧全髋关节置换术（BTHA）中第一阶段和第二阶段手术后并发症的发生率和复发率。并发症包括术后 30 至 60 天内的围手术期医疗不良事件，以及一年内的感染和机械并发症。计算条件概率和比值比（OR）以确定第一阶段手术后发生并发症是否会增加第二阶段发生相同并发症的风险。
共分析了 13829 例（5790 例男性和 8039 例女性）分期 BTHA 患者。第一次手术的平均年龄为 62.9 岁（14 至 95 岁）。在所评估的 12 项结果中的八项中，与第一次手术后未发生并发症的患者相比，第一次关节置换术后发生该结果的患者发生相同并发症的可能性和 OR 显著增加。这对于消化并发症（OR 25.67，95％置信区间（CI）13.86 至 46.08；p <0.001），泌尿系统并发症（OR 6.48，95％CI 1.7 至 20.73；p = 0.01），血肿（OR 12.17，95％CI 4.55 至 31.14；p <0.001），深静脉血栓形成（OR 4.82，95％CI 2.34 至 9.65；p <0.001），肺栓塞（OR 12.03，95％CI 2.02 至 46.77；p = 0.01），深部髋关节感染（OR 534.21，95％CI 314.96 至 909.25；p <0.001），浅部髋关节感染（OR 1574.99，95％CI 269.83 至 9291.81；p <0.001）和机械故障（OR 117.49，95％CI 91.55 至 150.34；p <0.001）。
单侧 THA 后发生某些并发症与对侧髋关节分期关节置换术后发生相同并发症的风险增加相关。单侧髋关节置换术后发生这些并发症的患者应在接受分期对侧髋关节置换术前适当咨询其风险状况。
