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Predicting Complications After Joint Replacement

Early discharge from the hospital is now standard practice after total hip or knee joint replacement. But serious complications can occur, including death. How soon can patients be safely released to go home? Researchers from the Rothman Institute of Orthopedics in Philadelphia may have the answer.

The records of 1,636 total hip and total knee patients during one year at the Rothman Institute were reviewed. Complications in the hospital and for six weeks after were recorded. All patients were followed by an internist during the follow-up.

Complications were put into two groups: systemic and local. Major systemic problems included any life-threatening condition such as heart attack, blood clot, and heart or kidney failure. Minor systemic complications included anemia, urinary tract infection, pneumonia, or change in mental status.

Local complications were also divided into major and minor problems. Nerve or blood vessel injury and bone fracture around the implant were examples of major local complications. Wound drainage or infection, skin blisters, and severe muscle spasm were listed as minor complications.

One patient in the group died and six per cent of the group had major complications. Most of the life-threatening complications happened in the first four days before discharge from the hospital. Some problems could be predicted based on patient's age, body mass index (BMI), and overall health. But more than half of the patients who ended up with life-threatening complications had no obvious risk factors.

The authors conclude hip and knee replacement continue to be one of the most safe and effective orthopedic surgeries today. Improvements in surgical techniques and anesthesia have reduced the number of deaths following joint replacement.

Even so, based on their results, they advise against current trends toward even shorter hospital stays. Patients who have minimally invasive operations are still at risk for the same major complications as with a standard joint replacement.

References: Javad Parvizi, MD, et al. Total Joint Arthroplasty: When Do Fatal or Near-Fatal Complications Occur? In The Journal of Bone and Joint Surgery. January 2007. Vol. 89A. No. 1. Pp. 27-32.

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