A study of nearly 720,000 hip and knee replacement patients has shown that clinicians should be aware of a patient's potential for post-operative complications relating to the digestive system as well as cardiovascular and respiratory risks.
The National Joint Registry for England, Wales, Northern Ireland and the Isle of Man (NJR) has carried out an in-depth study to better understand the causes of death following hip and knee replacement. The findings reinforce existing research which highlights complications relating to the heart are the most common cause of death soon after a hip or knee replacement, and one of the most common causes up to 10 years after. However, using the NJR's large dataset, researchers have found that there is also a marked increase in digestive disease related death in the 90 days following hip and knee replacement which needs clinical consideration.
Professor Ashley Blom, from the University of Bristol who led the team which undertook the study on behalf of the NJR, is calling upon clinicians working in the area of joint replacement to consider the study's findings to further reduce the risk of death and enhance a patient's outcome post-operation.
The study examined the causes and number of deaths of hip and knee joint replacement patients between 2003 to 2012 compared with those expected from the general population. The research team were able to study 56,568 deaths following 717,025 hip and knee replacement procedures for osteoarthritis over the nine year period.
Commenting on the reason for the study and its findings, Professor Blom said:
"It is important to remember that joint replacement is one of the most highly effective and cost effective interventions offered to patients with osteoarthritis. The chance of dying following joint replacement remains very low and has halved during the time the NJR has been collecting data, although older patients and males have higher death rates.
"This study has been carried out to better understand what clinical decisions and strategies could be taken to even further reduce the risk of death and enhance a patient's outcome following joint replacement.
"We expected cardiovascular related diseases to be the greatest cause of death in the immediate post-operative period following joint replacement surgery. Ischaemic heart disease accounted for around 30 per cent of deaths for both hip and knee replacement patients within 90 days. Further strategies could be introduced to target this and may lead to a reduced risk.
"However, the increased risk of digestive system related deaths was unexpected. Clinicians need to be aware of this and anticipate problems such as intestinal bleeds, obstructions and perforations. Patients identified with these potential problems or being at risk of them before their operation may require additional preventative strategies and a more rigorous post-operative monitoring and care plan.
"Tackling both cardiovascular and digestive disorders should not only increase life expectancy but enhance the cost-effectiveness of joint replacement."
Established in 2002, the NJR monitors the performance of hip, knee, ankle, elbow and shoulder joint replacements to improve clinical outcomes for the benefit of patients, clinicians and industry. As part of its programme of work the registry carries out in-depth studies to support decision-making in regard to patient safety, standards in quality of care and overall effectiveness of joint replacement surgery.
Concluding on the study's findings, NJR medical director, Mr Martyn Porter, commented:
"We shouldn't lose sight that joint replacement surgery offers significant benefits - getting patients back to their chosen lifestyle sooner, free from pain and with improved mobility.
"Undergoing surgery will ultimately cause a short-term increase in the risk of death, but this returns to a normal level between 30- and 90-days post-operation. These findings are important and should enable clinicians and patients to consider the balance between the short-term increased risks at the time of a hip or knee joint replacement operation compared to the longer-term benefits."
Article: Main Cause of Death Following Primary Total Hip and Knee Replacement for Osteoarthritis. A Cohort Study of 26,766 Deaths Following 332,734 Hip Replacements and 29,802 Deaths Following 384,291 Knee Replacements, Hunt, et al., The Journal of Bone and Joint Surgery, 2017.