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No generally increased risk of cancer after total hip arthroplasty performed due to osteoarthritis.

ABSTRACT: Previous studies on the risk of cancer after total hip arthroplasty (THA) contradict each other, and many are hampered by small cohort sizes, residual confounding, short observation times or a mix of indications underlying the THA procedure. We evaluated the risk of cancer after total hip arthroplasty due to osteoarthritis in a nationwide cohort by comparing cancer incidences in individuals exposed to total hip arthroplasty due to osteoarthritis and in unexposed, sex-, age- and residence matched individuals. To address some previous studies' shortcomings, information on comorbidity and socioeconomic background were obtained and adjusted for. We included 126,276 patients exposed to a cemented THA between 1992 and 2012, and 555,757 unexposed individuals. Follow-up started on the day of surgery for exposed individuals and respective date for matched, unexposed individuals, and ended on the day of death, emigration, censuring or December 31st, 2012, whichever came first. The Swedish Hip Arthroplasty Registry (SHAR), the Swedish Cancer Registry, the Swedish National Patient Registry and Statistics Sweden were accessed to obtain information on procedural details of the THA, cancer diagnoses, comorbidities, and socioeconomic background. The primary outcome measure was the occurrence of any cancer after the index date. Exposed individuals had a slightly lower adjusted risk of developing any cancer than unexposed individuals (hazard ratio [HR] 0.97; CI 0.95-0.99). The only cancer with a statistically significant risk increase in exposed individuals was skin melanoma (HR 1.15; CI 1.05-1.24). We attained similar risk estimates in analyses stratified by sex, in individuals with minimum 5 years of follow-up, in an analysis including individuals with a history of previous cancer, and in patients with cementless THA. In this study on a large and well-defined population with long follow-up, we found no increased overall risk of cancer after THA. These reassuring findings could be included in the guidelines on preoperative information given to THA patients.

SUBMITTER: Hailer NP

PROVIDER: S-EPMC7317978 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BackgroundThe purpose of this study was to evaluate the influence of discharge timing on 30-day complication rates following total hip arthroplasty.MethodsWe identified patients who underwent total hip arthroplasty between 2011 and 2017 from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. Using propensity score matching, we matched patients who were discharged from the hospital on the day of surgery to those discharged on postoperative days 1, 2, 3 and 4, respectively. We used multivariable logistic regression to determine if the rates of complications and readmission differed depending on length of stay.ResultsWe identified 141 594 patients who underwent total hip arthroplasty (average age 64.7 [standard deviation (SD) 11.4] yr) from the NSQIP database. The average length of stay was 2.3 days and decreased from 2.8 (SD 0.7) days in 2011 to 1.9 (0.9) days in 2017. The adjusted odds of a major complication increased by 1.33 (1.09-1.61) and 1.41 (1.05-2.21) for patients discharged on postoperative day 3 and 4, respectively, compared with patients discharged on postoperative day 2. Similarly, the adjusted odds of a minor complication increased by 1.22 (1.03-1.43) and 1.58 (1.11-2.26) for patients discharged on postoperative days 3 and 4, respectively, compared with those discharged on postoperative day 2. We found no difference in the risk of major or minor complications between patients discharged on the day of surgery or postoperative day 1 compared with patients discharged on postoperative day 2. We also found that a length of stay of 3 or 4 days increased the risk of readmission (odds ratio [OR] 1.15, 95% confidence interval [CI] 1.03-1.29, and OR 1.18, 95% CI 1.08-1.85, respectively) compared with a length of stay of 2 days.ConclusionOur data suggest that discharge on postoperative days 0-2 is associated with the lowest risk of 30-day complications following total hip arthroplasty. These findings support early discharge after total hip arthroplasty; however, more prospective clinical data are required to determine the optimal length of stay following total hip arthroplasty.

Project description:BackgroundSupercapsular percutaneously-assisted total hip (SuperPath) arthroplasty has been proposed to be minimally invasive and tissue sparing, with possible superior postoperative outcomes compared with conventional approaches for total hip arthroplasty (THA). However, previous studies have underlined the shortcomings of conventional THA approaches, including higher dislocation, more blood loss, longer incisions, more tissue damage, and delayed postoperative rehabilitation. In the present study, we compared the short-term outcomes of unilateral THA with those of SuperPath and the mini-incision posterolateral approach (PLA) for hip osteoarthritis (OA).MethodsPatients with unilateral hip OA were prospectively recruited and underwent either SuperPath (SuperPath group) or mini-incision PLA THA (PLA group). Perioperative status [operative time, incision length, intraoperative blood loss, soft tissue damage, and length of hospital stay (LOS)], and postoperative function outcomes, including range of motion (ROM), pain visual analog scale (VAS), and Harris Hip Score (HHS), were evaluated and compared between the groups at scheduled time points within 12 months postoperatively.ResultsCompared with the PLA group, the SuperPath group yielded a significantly shorter incision length (7.83 vs. 12.45 cm, P<0.001), longer operative time (102.72 vs. 66.22 min, P<0.001), more blood loss (1,007.38 vs. 844.55 mL, P=0.005), and more soft tissue damage (creatine kinase: 1,056.05 vs. 821.50 U/L, P=0.006) on postoperative day 3. The SuperPath group also showed deficient acetabular cup positioning (abduction angle: 36.94° vs. 42.66°, P=0.004) and a greater decrease in ROM (flexion: 107.66° vs. 114.44°, P=0.004; 109.83° vs. 116.11°, P=0.002; 111.66° vs. 118.88°, P<0.001) on postoperative days 1, 3, and 14, as well as severe early-term pain symptoms (pain VAS on postoperative day 3: 7.05 vs. 6.55, P=0.041). However, the LOS, C-reactive protein levels, erythrocyte sedimentation rate (within 2 weeks postoperatively), and HHS were comparable between the groups during the 12 months postoperatively.ConclusionsSuperPath may be a promising, minimally invasive technique for the treatment of OA in the future. Further investigation is necessary to evidence the possible superiority of SuperPath over other conventional mini-incision THA approaches.

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No generally increased risk of cancer after total hip arthroplasty performed due to osteoarthritis.

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