An Underlying Diagnosis of Osteoarthritis Is Associated with Better Outcomes after Total Hip Arthroplasty Than Avascular Necrosis of Bone

Jasvinder A. Singh¹, Jason Chen², Maria Inacio², Robert Namba² and Elizabeth Paxton², ¹University of Alabama at Birmingham, Birmingham, AL, ²Kaiser Permanente, San Diego, CA

Meeting: 2015 ACR/ARHP Annual Meeting

Date of first publication: September 29, 2015

Keywords: arthroplasty and outcomes, Hip

Session Information

Date: Monday, November 9, 2015

Session Title: Health Services Research Poster II (ACR): Healthcare Access, Patterns of Medication Use and Workforce Considerations

Session Type: ACR Poster Session B

Session Time: 9:00AM-11:00AM

Background/Purpose:

We recently showed that underlying diagnosis of RA was associated with higher readmission rate compared to osteoarthritis. Studies of adequate sample size assessing post-THA outcomes in patients with avascular necrosis are lacking. The objective of our study was to examine whether avascular necrosis as an underlying diagnosis was associated with a higher adjusted risk of complications and readmissions after primary THA, compared to OA.

Methods:

: We analyzed prospectively collected data from an integrated healthcare system Total Joint Replacement Registry of adults with avascular necrosis (AVN) vs. osteoarthritis (OA) undergoing unilateral primary THA during 2001-2012. We examined mortality (90-day), revision (ever), deep (1 year) and superficial (30-day) surgical site infection (SSI), venous thromboembolism (VTE, 90-day), and unplanned readmission (90-day). Age, gender, race, body mass index, American Society of Anesthesiologists class, and diabetes prevalence were evaluated as confounders. Logistic and Cox regression models were fit with variables significant in univariate models for each outcome. Odds ratios (OR) and hazard ratios with 95% confidence intervals (CI) were calculated.

Results:

Of the 47,523 primary THA cases, 45,252 (95.2%) had OA, and 2,271 (4.8%) had AVN. Compared to the OA cohort, the AVN patient cohort was younger (median age 55 vs. 67 years), had more male (57.5% vs. 41.7%), and less White (59.8% vs. 77.4%). Compared to the OA cohort, the AVN cohort had higher crude incidence of 90-day mortality (0.7% vs. 0.3%), revision (3.1% vs. 2.4%), SSI (1.2% vs. 0.8%), and unplanned readmission (9.6% vs. 5.2%). After multivariable-adjustment for significant factors, AVN patients had a higher likelihood of mortality (OR:2.48; 95% CI:1.31-4.72), SSI (OR:1.67, 95%CI:1.11 – 2.51), and unplanned readmissions (OR:2.20; 95% CI:1.67-2.91) than OA patients.

Conclusion:

OA was associated with better outcomes than AVN post-THA. Detailed discussion with AVN patients regarding the risk of complications is needed during the informed consent.

Disclosure: J. A. Singh, Takeda, Savient, 2,Takeda, Savient, merz, Regeneron, Allergan, Crealta, Bioiberica, 5; J. Chen, None; M. Inacio, None; R. Namba, None; E. Paxton, None.

To cite this abstract in AMA style:

Singh JA, Chen J, Inacio M, Namba R, Paxton E. An Underlying Diagnosis of Osteoarthritis Is Associated with Better Outcomes after Total Hip Arthroplasty Than Avascular Necrosis of Bone [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/an-underlying-diagnosis-of-osteoarthritis-is-associated-with-better-outcomes-after-total-hip-arthroplasty-than-avascular-necrosis-of-bone/. Accessed November 18, 2019.

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