Association between patient survival following reoperation after total hip replacement and the reason for reoperation: an analysis of 9,926 patients in the Swedish Hip Arthroplasty Register

Peter Cnudde,Erik Bülow,Szilard Nemes,Yosef Tyson,Maziar Mohaddes,Ola Rolfson

doi:10.1080/17453674.2019.1597062

Abstract

Background and purpose — The association between long-term patient survival and elective primary total hip replacement (THR) has been described extensively. The long-term survival following reoperation of THR is less well understood. We investigated the relative survival of patients undergoing reoperation following elective THR and explored an association between the indication for the reoperation and relative survival.Patients and methods — In this observational cohort study we selected the patients who received an elective primary THR and subsequent reoperations during 1999–2017 as recorded in the Swedish Hip Arthroplasty Register. The selected cohort was followed until the end of the study period, censoring or death. The indications for 1st- and eventual 2nd-time reoperations were analyzed and the relative survival ratio of the observed survival and the expected survival was determined.Results — There were 9,926 1st-time reoperations and of these 2,558 underwent further reoperations. At 5 years after the latest reoperation, relative survival following 1st-time reoperations was 0.94% (95% CI 0.93–0.96) and 0.90% (CI 0.87–0.92) following 2nd-time reoperations. At 5 years patients with a 1st-time reoperation for aseptic loosening had higher survival than expected; however, reoperations performed for periprosthetic fracture, dislocation, and infection had lower survival.Interpretation — The relative survival following 1st- and 2nd-time reoperations in elective THR patients differs by reason for reoperation. The impact of reoperation on life expectancy is more obvious for infection/dislocation and periprosthetic fracture.

Highlights

The association between long-term patient survival and elective primary total hip replacement (THR) has been described extensively
Using the Swedish Hip Arthroplasty Register (SHAR) databases, 278,309 primary THRs were identified in the study period from January 1, 1999 to December 31, 2017
Patients who underwent reoperation for infection and aseptic loosening were generally younger at the time of their surgery than patients undergoing the procedure for dislocation and periprosthetic fracture

Summary

Introduction

The association between long-term patient survival and elective primary total hip replacement (THR) has been described extensively. We investigated the relative survival of patients undergoing reoperation following elective THR and explored an association between the indication for the reoperation and relative survival. At 5 years patients with a 1st-time reoperation for aseptic loosening had higher survival than expected; reoperations performed for periprosthetic fracture, dislocation, and infection had lower survival. Interpretation — The relative survival following 1stand 2nd-time reoperations in elective THR patients differs by reason for reoperation. While the risk of dying and life expectancy following a primary THR has been studied extensively, patient survival after further surgical interventions is virtually unexplored (Jones et al 2018, Yao et al 2018). The relative survival method has been developed to provide better insights into the relation between a study population and a general population (Stare et al 2005)

Methods

Results

Conclusion