An underlying diagnosis of osteonecrosis of bone is associated with worse outcomes than osteoarthritis after total hip arthroplasty

BMC Musculoskelet Disord. 2017 Jan 9;18(1):8. doi: 10.1186/s12891-016-1385-0.

Abstract

Background: Well-designed studies of complications and readmission rates in patients undergoing total hip arthroplasty (THA) with osteonecrosis are lacking. Our objective was to examine if a diagnosis of osteonecrosis was associated with complications, mortality and readmission rates after THA.

Methods: We analyzed prospectively collected data from an integrated healthcare system's Total Joint Replacement Registry of adults with osteonecrosis vs. osteoarthritis (OA) undergoing unilateral primary THA during 2001-2012, in an observational cohort study. We examined mortality (90-day), revision (ever), deep (1 year) and superficial (30-day) surgical site infection (SSI), venous thromboembolism (VTE, 90-day), and unplanned readmission (90-day). Age, gender, race, body mass index, American Society of Anesthesiologists class, and diabetes were evaluated as confounders. We used logistic or Cox regression to calculate odds or hazard ratios (OR, HR) with 95% confidence intervals (CI).

Results: Of the 47,523 primary THA cases, 45,252 (95.2%) had OA, and 2,271 (4.8%) had osteonecrosis. Compared to the OA, patients with osteonecrosis were younger (median age 55 vs. 67 years), and were less likely to be female (42.5% vs. 58.3%) or White (59.8% vs. 77.4%). Compared to the OA, the osteonecrosis cohort had higher crude incidence of 90-day mortality (0.7% vs. 0.3%), SSI (1.2% vs. 0.8%), unplanned readmission (9.6% vs. 5.2%) and revision (3.1% vs. 2.4%). After multivariable-adjustment, patients with osteonecrosis had a higher odds/hazard of mortality (OR: 2.48; 95% CI:1.31-4.72), SSI (OR: 1.67, 95%CI:1.11-2.51), unplanned 90-day readmissions (OR: 2.20; 95% CI:1.67-2.91) and a trend towards higher revision rate 1-year post-THA (HR: 1.32; 95% CI: 0.94-1.84), than OA patients.

Conclusions: Compared to OA, a diagnosis of osteonecrosis was associated with worse outcomes post-THA. A detailed preoperative discussion including the risk of complications is needed for informed consent from patients with osteonecrosis.

Keywords: Arthroplasty; Diagnosis; Joint replacement; Osteoarthritis; Osteonecrosis; Readmission; Risk factor; Total hip replacement.

Publication types

  • Comparative Study
  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Arthroplasty, Replacement, Hip / adverse effects*
  • Female
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Odds Ratio
  • Osteoarthritis / complications
  • Osteoarthritis / mortality
  • Osteoarthritis / surgery*
  • Osteonecrosis / complications
  • Osteonecrosis / mortality
  • Osteonecrosis / surgery*
  • Patient Readmission / statistics & numerical data
  • Reoperation / statistics & numerical data*
  • Risk Factors
  • Surgical Wound Infection / epidemiology*
  • Surgical Wound Infection / etiology
  • Treatment Outcome
  • Venous Thromboembolism / epidemiology*
  • Venous Thromboembolism / etiology