Septic revision THA carries 33% mortality rate within 5 years

CHICAGO — Researchers of a matched-cohort study of revision total hip arthroplasties found higher mortality among septic cases compared to aseptic cases during a short follow-up.

“Our mortality rate in the revision total hip arthroplasty [group] for sepsis was 33%, so a third of patients died in a follow-up of 5 years. [This was] 22% for the aseptic group. In the septic group, the only predictor of failure was the Charlson Comorbidity Index. It was completely independent of age. It is alarming to us that for patients with an average age of 66 years, one-third were deceased within 5 years of surgery,” Hany Bedair, MD, said during his presentation here at the American Academy of Orthopaedic Surgeons Annual Meeting.

Bedair and colleagues identified 93 patients who were revised for sepsis with an intended two-stage procedure and matched the group with a cohort of 93 patients who underwent revision for aseptic failure. The groups were similar regarding patient demographics. However, there were more patients in the sepsis group who were ASA grades 3 and 4. The sepsis group also had a higher Charlson Comorbidity Index (CCI) compared to the aseptic group. The study had an average follow-up of 5.5 years.

Using the Social Security Death Index and the medical recorders from the researchers’ institution, they found overall mortality rate of 27% for revision total hip arthroplasty. The mortality rate for the aseptic group was 22% vs. 33% for the septic group. While this finding was not statistically significant, Bedair said the study may have been inadequately powered.

“When we looked at the people who did die and at what age they passed away, we found that in the aseptic group, the average age at death was 88.5 years, and in the septic group it was 74 years. That was statistically different,” he said.

For the sepsis group, the investigators found that CCI was a predictor of mortality. They found no correlation between age and mortality after revision, the bacterial species found or antimicrobial resistance for this group.

“There is basically no difference in your mortality rate if you were 50 years old compared to if you were 80 years old,” Bedair said.

To put his group’s findings into perspective, Bedair noted previous studies have cited an average mortality of 31% at 6 years following primary total hip arthroplasty for hip fracture.

Reference:

Bedair H. Paper #278. Presented at the: American Academy of Orthopaedic Surgeons Annual Meeting; March 19-23, 2013; Chicago.

Disclosure: Bedair has no relevant financial disclosures.