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01-09-2015 | Original Paper

Validation of the Charlson comorbidity index in patients undergoing revision total hip arthroplasty

Authors: Jan Schmolders, Max J. Friedrich, Robert Michel, Andreas C. Strauss, Matthias D. Wimmer, Thomas M. Randau, Peter H. Pennekamp, Dieter C. Wirtz, Sascha Gravius

Published in: International Orthopaedics | Issue 9/2015

Abstract

Purpose

The Charlson comorbidity index (CCI) was developed to quantify the influence of comorbidities on survival. The age-related CCI respects patients’ age as an additional risk factor. There are several studies available based on administrative data regarding functional outcome, implant survival, resource use and length of hospital stay in patients undergoing primary total hip arthroplasty (THA). To date, there is a lack of knowledge regarding the correlation of the CCI and the age-related CCI in case of revision total hip arthroplasty (RTHA).

Objective

Our objective was to validate the influence of the CCI and age-related CCI in patients undergoing RTHA regarding complication rate, resource use implant survival and mortality rate.

Methods

Between October 2007 and November 2012, 142 consecutive patients undergoing RTHA were included in this retrospective study. Routine clinical data were collected and analysed as anonymized aggregated data. In accordance to CCI and age-related CCI the rate of complications (internal medical and surgical complications), the length of hospital stay and the need for ICU treatment and the mortality rate was evaluated. Kaplan-Meier survivorship was used to determine implant survival.

Results

Twenty-one patients (15 %) had a low risk CCI, 59 patients (41 %) a moderate risk CCI and 62 patients (44 %) a high risk CCI. The mean follow-up was 27 months (range 24–70 months). In total, we recorded 57 complications (40 %), of which 45 were surgical (79 %) and 12 were internal medical complications (21 %). Twenty-four patients (17 %) had to undergo revision surgery. CCI and age-related CCI had no influence regarding implant survival. We recorded a significant influence of the age-related CCI in regard to the necessity of postoperative intensive care unit stay and the length of total hospital stay. Further we recorded a significant influence of the CCI and the age-related CCI regarding postoperative complications and internal complications, postoperative dislocation and the need for surgical revision.

Conclusion

In summary, we conclude that the CCI and the age-related CCI are strong predictors regarding complication rate in patients undergoing RTHA. In a short- to mid-term follow-up, no influence on implant survival is detectable.

Rius C, Perez G, Martinez JM, Bares M, Schiaffino A, Gispert R, Fernandez E (2004) An adaptation of Charlson comorbidity index predicted subsequent mortality in a health survey. J Clin Epidemiol 57:403–408. doi:10.1016/j.jclinepi.2003.09.016 CrossRefPubMed

Deyo RA, Cherkin DC, Ciol MA (1992) Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol 45:613–619CrossRefPubMed

de Groot V, Beckerman H, Lankhorst GJ, Bouter LM (2003) How to measure comorbidity. A critical review of available methods. J Clin Epidemiol 56:221–229CrossRefPubMed

Reininga IH, Wagenmakers R, van den Akker-Scheek I, Stant AD, Groothoff JW, Bulstra SK, Zijlstra W, Stevens M (2007) Effectiveness of computer-navigated minimally invasive total hip surgery compared to conventional total hip arthroplasty: design of a randomized controlled trial. BMC Musculoskelet Disord 8:4. doi:10.1186/1471-2474-8-4 PubMedCentralCrossRefPubMed

Johnsen SP, Sorensen HT, Lucht U, Soballe K, Overgaard S, Pedersen AB (2006) Patient-related predictors of implant failure after primary total hip replacement in the initial, short- and long-terms. A nationwide Danish follow-up study including 36,984 patients. J Bone Joint Surg Br 88:1303–1308. doi:10.1302/0301-620X.88B10.17399 CrossRefPubMed

Kreder HJ, Grosso P, Williams JI, Jaglal S, Axcell T, Wal EK, Stephen DJ (2003) Provider volume and other predictors of outcome after total knee arthroplasty: a population study in Ontario. Can J Surg J Can Chir 46:15–22

Hall SF, Groome PA, Streiner DL, Rochon PA (2006) Interrater reliability of measurements of comorbid illness should be reported. J Clin Epidemiol 59:926–933. doi:10.1016/j.jclinepi.2006.02.006 CrossRefPubMed

Dreinhofer KE, Dieppe P, Sturmer T, Grober-Gratz D, Floren M, Gunther KP, Puhl W, Brenner H (2006) Indications for total hip replacement: comparison of assessments of orthopaedic surgeons and referring physicians. Ann Rheum Dis 65:1346–1350. doi:10.1136/ard.2005.047811 PubMedCentralCrossRefPubMed

Peersman G, Laskin R, Davis J, Peterson M (2001) Infection in total knee replacement: a retrospective review of 6489 total knee replacements. Clin Orthop Relat Res 392:15–23

10.

Trampuz A, Zimmerli W (2008) Diagnosis and treatment of implant-associated septic arthritis and osteomyelitis. Curr Infect Dis Rep 10:394–403CrossRefPubMed

11.

Marculescu CE, Berbari EF, Hanssen AD, Steckelberg JM, Harmsen SW, Mandrekar JN, Osmon DR (2006) Outcome of prosthetic joint infections treated with debridement and retention of components. Clin Infect Dis Off Publ Infect Dis Soc Am 42:471–478. doi:10.1086/499234 CrossRef

12.

Pulido L, Ghanem E, Joshi A, Purtill JJ, Parvizi J (2008) Periprosthetic joint infection: the incidence, timing, and predisposing factors. Clin Orthop Relat Res 466:1710–1715. doi:10.1007/s11999-008-0209-4 PubMedCentralCrossRefPubMed

13.

Kurtz S, Ong K, Lau E, Mowat F, Halpern M (2007) Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am 89:780–785. doi:10.2106/JBJS.F.00222 CrossRefPubMed

14.

Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383CrossRefPubMed

15.

Charlson M, Szatrowski TP, Peterson J, Gold J (1994) Validation of a combined comorbidity index. J Clin Epidemiol 47:1245–1251CrossRefPubMed

16.

Wimmer MD, Vavken P, Pagenstert GI, Valderrabano V, Randau TM, Wirtz DC, Gravius S (2013) Spacer usage in prosthetic joint infections does not influence infect resolution: retrospective analysis of 120 joints with two-stage exchange. Re: Clinical outcome and microbiological findings using antibiotic-loaded spacers in two-stage revision of prosthetic joint infections. Cabo J, Euba G, Saborido A, Gonzalez-Panisello M, Dominguez MA, Agullo JL, Murillo O, Verdaguer R, Ariza J. J Infection 2011 63(1):23. J Inf 67:82–84. doi:10.1016/j.jinf.2013.02.001

17.

Weiss S, Geiss H, Kommerell M, Simank HG, Bernd L, Henle P (2006) Improving the diagnosis of septic arthritis by use of a pediatric blood culture system. Orthopade 35(456):458–462. doi:10.1007/s00132-005-0900-z

18.

Trampuz A, Steinrucken J, Clauss M, Bizzini A, Furustrand U, Uckay I, Peter R, Bille J, Borens O (2010) New methods for the diagnosis of implant-associated infections. Rev Med Suisse 6:731–734PubMed

19.

Paprosky WG, O’Rourke M, Sporer SM (2005) The treatment of acetabular bone defects with an associated pelvic discontinuity. Clin Orthop Relat Res 441:216–220CrossRefPubMed

20.

Morawietz L, Gehrke T, Schroder JH, Krenn V (2006) Histopathological diagnostics in endoprosthesis loosening. Pathologe 27:439–445. doi:10.1007/s00292-006-0867-5 CrossRefPubMed

21.

Parvizi J, Heller S, Berend KR, Della Valle CJ, Springer BD (2015) Periprosthetic joint infection: the algorithmic approach and emerging evidence. Instr Course Lect 64:51–60PubMed

22.

Wimmer MD, Randau TM, Petersdorf S, Pagenstert GI, Weisskopf M, Wirtz DC, Gravius S (2013) Evaluation of an interdisciplinary therapy algorithm in patients with prosthetic joint infections. Int Orthop 37:2271–2278. doi:10.1007/s00264-013-1995-1 PubMedCentralCrossRefPubMed

23.

Schmolders J, Friedrich MJ, Michel RD, Randau TM, Wimmer MD, Strauss AC, Kohlhof H, Wirtz DC, Gravius S (2015) Acetabular defect reconstruction in revision hip arthroplasty with a modular revision system and biological defect augmentation. Int Orthop 39(4):623–630. doi:10.1007/s00264-014-2533-5

24.

Friedrich MJ, Gravius S, Schmolders J, Wimmer MD, Wirtz DC (2014) Biological acetabular defect reconstruction in revision hip arthroplasty using impaction bone grafting and an acetabular reconstruction ring. Oper Orthop Traumatol 26:126–140. doi:10.1007/s00064-013-0270-3 CrossRefPubMed

25.

Friedrich MJ, Schmolders J, Michel RD, Randau TM, Wimmer MD, Kohlhof H, Wirtz DC, Gravius S (2014) Management of severe periacetabular bone loss combined with pelvic discontinuity in revision hip arthroplasty. Int Orthop 38:2455–2461. doi:10.1007/s00264-014-2443-6 CrossRefPubMed

26.

Wirtz DC, Gravius S, Ascherl R, Thorweihe M, Forst R, Noeth U, Maus UM, Wimmer MD, Zeiler G, Deml MC (2014) Uncemented femoral revision arthroplasty using a modular tapered, fluted titanium stem: 5- to 16-year results of 163 cases. Acta Orthop 85:562–569. doi:10.3109/17453674.2014.958809 PubMedCentralCrossRefPubMed

27.

Soohoo NF, Zingmond DS, Lieberman JR, Ko CY (2006) Primary total knee arthroplasty in California 1991 to 2001: does hospital volume affect outcomes? J Arthroplast 21:199–205. doi:10.1016/j.arth.2005.03.027 CrossRef

28.

Weaver F, Hynes D, Hopkinson W, Wixson R, Khuri S, Daley J, Henderson WG (2003) Preoperative risks and outcomes of hip and knee arthroplasty in the Veterans Health Administration. J Arthroplast 18:693–708CrossRef

29.

Malchau H, Herberts P, Eisler T, Garellick G, Soderman P (2002) The Swedish total hip replacement register. J Bone Joint Surg Am 84-A(Suppl 2):2–20PubMed

30.

Bjorgul K, Novicoff WM, Saleh KJ (2010) Evaluating comorbidities in total hip and knee arthroplasty: available instruments. J Orthop Traumatol: Off J Ital Soc Orthop Traumatol 11:203–209. doi:10.1007/s10195-010-0115-x CrossRef

Title: Validation of the Charlson comorbidity index in patients undergoing revision total hip arthroplasty
Authors: Jan Schmolders
Max J. Friedrich
Robert Michel
Andreas C. Strauss
Matthias D. Wimmer
Thomas M. Randau
Peter H. Pennekamp
Dieter C. Wirtz
Sascha Gravius
Publication date: 01-09-2015
Publisher: Springer Berlin Heidelberg
Published in: International Orthopaedics / Issue 9/2015
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-015-2810-y

At a glance: The STEP trials

Springer Medicine

Validation of the Charlson comorbidity index in patients undergoing revision total hip arthroplasty

Abstract

Purpose

Objective

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Objective

Methods

Results

Conclusion

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