Removal of an Infected Hip Arthroplasty Is a High-Risk Surgery: Putting Morbidity Into Context With Other Major Nonorthopedic Operations

Abstract

BackgroundTwo-stage revision remains the most common approach to periprosthetic joint infection of total hip arthroplasty (THA) in the United States. The postoperative risks associated with removal of an infected prosthesis and placement of a spacer have not been thoroughly studied. MethodsPatients who underwent THA implant removal and spacer placement for infection were identified in a large administrative database. Morbidity and mortality rates were assessed for the 90-day postoperative period and readmission rates were assessed at 30 days postoperatively. These outcomes were then compared with those after coronary artery bypass grafting, carotid endarterectomy, prostatectomy, pancreatoduodenectomy (Whipple procedure), and kidney transplant. ResultsImplant removal and spacer placement for THA periprosthetic joint infection (n = 10,386) had a 30-day readmission rate of 11.1% and 90-day mortality rate of 2.6%. Major complications were seen in 15.3% patients. Postoperative morbidity was often higher in these patients when compared with other procedures studied. Ninety-day mortality rates were significantly higher compared with carotid endarterectomy, prostatectomy, and kidney transplant (odds ratio [ORs] between 2.1 and 12.5; P < .0001). Readmission rates at 30 days were significantly higher than all other groups including coronary artery bypass grafting and Whipple (ORs between 1.4 and 8.2; P < .0001). ConclusionRemoval of an infected THA with spacer placement is a high-risk surgery. This large study that includes over 10,000 patients helps quantify the risks of readmission, morbidity, and mortality. The rates of adverse outcomes are higher than those for many nonorthopedic operations typically considered to be major surgery.