Impact of comorbidities on the safety and effectiveness of hip and knee arthroplasty surgery: A national observational study

Podmore, Bélène, Hutchings, Andrew, Skinner, John A., Macgregor, Alexander J. ORCID: and Van Der Meulen, Jan (2021) Impact of comorbidities on the safety and effectiveness of hip and knee arthroplasty surgery: A national observational study. Bone & Joint Journal, 103-B (1). pp. 56-64. ISSN 2049-4394

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AIMS: Access to joint replacement is being restricted for patients with comorbidities in a number of high-income countries. However, there is little evidence on the impact of comorbidities on outcomes. The purpose of this study was to determine the safety and effectiveness of hip and knee arthroplasty in patients with and without comorbidities. METHODS: In total, 312,079 hip arthroplasty and 328,753 knee arthroplasty patients were included. A total of 11 common comorbidities were identified in administrative hospital records. Safety risks were measured by assessing length of hospital stay (LOS) and 30-day emergency readmissions and mortality. Effectiveness outcomes were changes in Oxford Hip or Knee Scores (OHS/OKS) (scale from 0 (worst) to 48 (best)) and in health-related quality of life (EQ-5D) (scale from 0 (death) to 1 (full health)) from immediately before, to six months after, surgery. Regression analysis was used to estimate adjusted mean differences (LOS, change in OHS/OKS/EQ-5D) and risk differences (readmissions and mortality). RESULTS: Patients with comorbidities had a longer LOS and higher readmission and mortality rates than patients without. In hip arthroplasty patients with heart disease, for example, LOS was 1.20 days (95% confidence interval (CI) 1.15 to 1.25) longer and readmission rate was 1.52% (95% CI 1.34% to 1.71%) and mortality 0.19% (95% CI 0.15% to 0.23%) higher. Similar patterns were observed for knee arthroplasty patients. Patients without comorbidities reported large improvements in function (mean improvement OHS 21.3 (SD 9.91) and OKS 15.9 (SD 10.0)). Patients with comorbidities reported only slightly smaller improvements. In patients with heart disease, mean improvement in OHS was 0.39 (95% CI 0.27 to 0.51) and in OKS 0.56 (95% CI 0.45 to 0.67) less than in patients without comorbidities. There were no significant differences in EQ-5D improvement. CONCLUSION: Comorbidities were associated with small increases in adverse safety risks but they have little impact on pain or function in patients undergoing hip or knee arthroplasty. These results do not support restricting access to hip and knee arthroplasty for patients with common comorbidities. Cite this article: Bone Joint J 2021;103-B(1):56-64.

Item Type: Article
Additional Information: Funding Information: This work was supported by the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care North Thames at Barts Health NHS Trust. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The authors choose not to provide any additional funding statements. Publisher Copyright: © 2021 British Editorial Society of Bone and Joint Surgery. All rights reserved.
Uncontrolled Keywords: comorbidity,hip arthroplasty,knee arthroplasty,outcomes,surgery,orthopedics and sports medicine ,/dk/atira/pure/subjectarea/asjc/2700/2746
Faculty \ School: Faculty of Medicine and Health Sciences > Norwich Medical School
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Depositing User: LivePure Connector
Date Deposited: 19 Jan 2021 00:57
Last Modified: 22 Oct 2022 07:39
DOI: 10.1302/0301-620X.103B1.BJJ-2020-0859.R1

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