Background: With the recent trend toward minimally invasive total
joint arthroplasty and the increased emphasis on faster recovery and shorter
hospital stays, it has become increasingly important to recognize the timing
and severity of the various complications associated with elective total joint
arthroplasty to ensure that early patient discharge is a safe practice.
Methods: We evaluated the systemic and local complications
associated with primary unilateral lower-extremity arthroplasties performed
during one year in 1636 patients. A total of 966 patients had a primary total
hip arthroplasty, and 670 had a primary total knee arthroplasty. All
complications that occurred in the hospital and for six weeks following the
index surgery were recorded. The circumstances leading to the complications
and the details of the therapeutic intervention for each complication were
recorded. Analyses were performed to predict the factors that predispose
patients to serious complications.
Results: One patient (0.06%) in the cohort died during the hospital
stay. There were a total of 104 major (life-threatening) complications,
including cardiac arrest (one), tachyarrhythmia (thirty-three), pulmonary
edema or congestive heart failure (ten), myocardial infarction (six),
hypotensive crisis (four), pulmonary embolus (twenty-five), acute renal
failure (fourteen), stroke (six), bowel obstruction or perforation (three),
and pneumothorax (one). There were seventeen major local complications.
Ninety-four (90%) of the major complications occurred within four days after
the index surgery. Although older age, increased body mass, and preexistent
comorbidities were important predisposing factors for serious medical
complications, 58% of the patients who had life-threatening complications
develop had no identifiable predisposing factors.
Conclusions: This study demonstrated that most of the complications
of lower-extremity total joint replacement occur within the time-frame of the
typical hospital stay. Given the serious nature of some of these complications
and the inability to identify many of the patients who may be at risk, we
caution against early discharge of patients from the hospital after elective
total joint arthroplasty in the lower extremity.
Level of Evidence: Therapeutic Level III. See
Instructions to Authors for a complete description of levels of evidence.