An evaluation of peri-operative clinical, serological and radiological parameters in hip arthroplasties -a prospective observational study of Indian cohorts

Background The scarcity of mortality data in our country led to systematic effort with aim of evaluating peri-operative parameters associated with mortality in hip arthroplasties to determine better fixation method and reducing avoidable variables. Materials & methods 252 consecutive patients (133 males and 119 females; Mean age 58.68 years) operated for hip arthroplasties (cemented & uncemented THR and bipolar hemiarthroplasty) were observed prospectively for 2 years. Heart-rate, O2 saturation and BP were recorded at specific surgical steps and post-operatively for 48 h. Post-operative Trop-T and 2D Echocardiography were done in all patients and D-Dimer and CTPA in indicated ones. All post-operative deaths were extensively studied. Results - Majority (63%) were operated for traumatic indications.48% belonged to ASA grade-1, 46% grade-2 and 4% grade-3. There was statistically significant association of diagnosis (traumatic aetiology), ASA grade 2, raised Troponin -T, raised D-dimer and pulmonary embolism with mortality. Mortality rate in our study at post-op 48 h was 5.5%, 30 day- 8% and 1-year mortality rate was 19%. With total of 14 deaths, 8 deaths (57.14%) occurred among 127 cemented arthroplasties and 6 deaths (42.86%) among 125 uncemented arthroplasties. Conclusions Selection of implant (cemented or uncemented) made no difference in eventual mortality. Collaborative effort of orthopaedic surgeon, anaesthetist and experts from respective fields in elderly high-risk patient with vigilant post-operative surveillance for minimum 48 h would help in lowering mortality associated with hip arthroplasties.