Strategies for Surviving Hip Replacement

Death risk after total hip replacement affected by surgical techniques and pre existing conditions

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

(RxWiki News) Total hip replacement is a major surgery that sometimes requires a long recovery. In rare cases, patients die soon after the surgery. However, there may be ways to lower that risk.

A recent study examined the factors that could contribute to death in the 90 days following a total hip replacement. The researchers looked at data from over 400,000 cases to see which patient and treatment features were linked to an increased risk of death.

The researchers found that certain approaches to the surgery may reduce the risk of death. Additionally, patients without serious illnesses like liver disease or cancer had a lower risk of death directly following the surgery.

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Linda Hunt, PhD, of the Musculoskeletal Research Unit in the School of Clinical Sciences at the University of Bristol, led this study to see if there are factors contributing to death after a total hip replacement.

Hip replacement surgery is a major operation normally recommended to older people who suffer from severe arthritis pain or who have joint damage.

Death after hip replacement is rare. However, preventative measures exist to reduce the risk of death, such as medications and devices designed to prevent blood clots.

For this study, the researchers used the National Joint Registry for England and Wales, which has data on patients who have undergone total hip replacement. They linked the data from the National Joint Registry to the national mortality database and the Hospital Episode Statistics database to gather more information about the patients.

Altogether, the researchers identified 409,096 people who had received a total hip replacement between April 2003 and December 2011 in order to treat osteoarthritis.

They found that 1,743 patients died within the first 90 days after surgery. Men were more likely than women to die in the 90 days after surgery, and the risk increased with age.

The researchers also found that certain factors of the surgery itself contributed to a lower risk of death.

For example, use of a spinal anesthetic lowered the risk of death, probably because general anesthetic and morphine-like medications carry the risk of respiratory problems.

Posterior surgery, or an approach from the back of the body rather than the side, was also associated with a lower risk of death. The researchers suggested the lower death risk may be attributed to less bleeding and better muscle preservation.

Also, when chemical measures like blood thinners were taken to prevent blood clots, death risk dropped significantly.

Assuming that the statistics point to causal associations, the authors wrote that if each patient's surgery involved a posterior approach, spinal anesthetic and chemical prevention of blood clots, death rates in the 90 days after total hip replacement would have dropped by one fifth.

The researchers also found that patients who had certain simultaneous illnesses or health conditions were more likely to die in the 90 days immediately following the surgery.

People who had severe liver disease were ten times more likely to die soon after a hip replacement, and people with cancer were seven times more likely than the average patient. Congestive heart failure, previous heart attack, and renal disease amplified death risk in the 90 days following surgery by two or three times compared to patients without those conditions.

According to the researchers, this study had some weaknesses because it was observational, so they cannot assume that certain factors contribute to a higher death risk after total hip replacement.

However, because the National Joint Registry is the largest joint replacement database in the world and the sample size was so large, the researchers say that the findings are fairly reliable.

The researchers concluded that the data points to better practices for total hip replacement, and that more research is needed to identify factors affecting death risk.

This study was published in The Lancet on September 26.

The research was funded by the National Joint Registry for England and Wales. The authors declared no conflicts of interest.

Review Date: 
September 24, 2013
Last Updated:
September 26, 2013