Fast-track revision hip arthroplasty: a multicenter cohort study on 1,345 elective aseptic major component revision hip arthroplasties

Martin Lindberg-Larsen; Pelle Baggesgaard  Petersen; Yasemin Corap; Kirill Gromov; Christoffer Calov Jørgensen; Henrik Kehlet; on behalf of the Centre for Fast-track Hip and Knee Replacement Collaborating Group

doi:10.2340/17453674.2022.2196

Authors

Martin Lindberg-Larsen Orthopaedic Research Unit, Department of Orthopaedic Surgery and Traumatology, Odense University Hospital; Department of Clinical Research, University of Southern Denmark; Centre for Fast-track Hip and Knee Arthroplasty, Copenhagen, Denmark https://orcid.org/0000-0002-4483-677X
Pelle Baggesgaard Petersen Section for Surgical Pathophysiology, Rigshospitalet, Copenhagen, Denmark https://orcid.org/0000-0002-0727-7067
Yasemin Corap Orthopaedic Research Unit, Department of Orthopaedic Surgery and Traumatology, Odense University Hospital; Department of Clinical Research, University of Southern Denmark https://orcid.org/0000-0003-3690-6157
Kirill Gromov Centre for Fast-track Hip and Knee Arthroplasty, Copenhagen, Denmark: Department of Orthopedics, Hvidovre Hospital, Hvidovre, Denmark https://orcid.org/0000-0002-8114-5193
Christoffer Calov Jørgensen Section for Surgical Pathophysiology, Rigshospitalet, Copenhagen, Denmark https://orcid.org/0000-0001-6902-8181
Henrik Kehlet Centre for Fast-track Hip and Knee Arthroplasty, Copenhagen, Denmark; Section for Surgical Pathophysiology, Rigshospitalet, Copenhagen, Denmark https://orcid.org/0000-0002-2209-1711
on behalf of the Centre for Fast-track Hip and Knee Replacement Collaborating Group

DOI:

https://doi.org/10.2340/17453674.2022.2196

Keywords:

enhanced recovery, fast-track, Hip, readmission, revision hip arthroplasty, revision hip replacement

Abstract

Background and purpose: Data on application of fasttrack/enhanced recovery protocols in revision hip arthroplasty (R-THA) surgery is scarce. We report length of stay (LOS), risk of LOS > 5 days, and readmission ≤ 90 days after revision hip arthroplasty in centers with a well-established fast-track protocol in both primary and revision procedures.

Patients and methods: This is an observational cohort study from the Centre for Fast-track Hip and Knee Replacement and the Danish Hip Arthroplasty Register. Consecutive elective aseptic major component revision hip arthroplasties from 6 dedicated fast-track centers from 2010 to 2018 were included.

Results: 1,345 R-THAs were analyzed, including 23% total revisions, 52% acetabular component revisions, and 25% femoral component revisions. Mean age was 70 years (SD 12) and 61% were female. Median LOS was 3 days (interquartile range [IQR] 2–6), decreasing from median 6 (IQR 3–10) days in 2010 to 2 (IQR 1–4) days in 2018. The 90-day readmission rate was 20%, but showed a fluctuating and increasing trend from 13% in 2010 to 28% in 2018. Risk factors for LOS > 5 days and readmission were use of walking aid, preoperative hemoglobin ≤ 13 g/dL, pharmacological treated psychiatric disorder, age ≥ 80 years, age 70–79 years (only LOS > 5 days), cardiac disease (only LOS > 5 days), pulmonary disease (only readmission), BMI ≥ 35 (only LOS > 5 days) and ≥ 1 previous revision (only LOS > 5 days).

Interpretation: LOS decreased to median 2 days at the end of the study period, but the 90 days readmission risk remained high (> 20%). Several risk factors for postoperative complications were identified, suggesting that at-risk patients should be treated using an extended fast-track/enhanced recovery protocol focusing on preoperative optimization and postoperative monitoring as well as surgical techniques to reduce hip dislocations.