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Operating time and survival of primary total hip replacements: an analysis of 31,745 primary cemented and uncemented total hip replacements from local hospitals reported to the Norwegian Arthroplasty Register 1987-2001. 2004

Arvid Småbrekke, and Birgitte Espehaug, and Leif I Havelin, and Ove Furnes
Department of Orthopaedic Surgery, Hammerfest Hospital, Sykehusveien 35, NO-9600 Hammerfest, Norway. Smaabrekke@hammerfest-sykehus.no

BACKGROUND Some studies have found a significant decrease in operating time as a result of standardizing programs for hip surgery. To study the influence of operating time (skin to skin) on survival of total hip replacements, we investigated the operating time in local hospitals in Norway. We have found no other large published series of THRs investigating operating time and revision. METHODS The study was based on 31,745 primary THRs reported to the Norwegian Arthroplasty Register from 47 local hospitals during 1987-2001. Operating time was divided into 7 categories, and for each category separate Kaplan-Meier curves and adjusted failure rate ratios were calculated. RESULTS The mean operating time for all local hospitals in Norway was 96 (68-130) min. Increasing operating volume from less than 10 THRs/hospital/year to more than 200 THRs/hospital/year was associated with a 25-min decrease in mean operating time in cemented THRs and a 35-min decrease in the case of uncemented THRs. With the operating time category of 71-90 min as reference category, cemented THRs that lasted more than 150 min had a two-fold increased (95% CI: 1.6-2.6) revision rate. For uncemented implants, the revision rate was 1.3 times higher (95% CI: 0.8-2.2). Cemented implants with operating time under 51 min and over 90 min were associated with an increased risk of revision due to aseptic loosening. Cemented implants with operating time over 150 min were associated with an increased risk of revision due to infection. CONCLUSIONS Hospitals with long operating times should consider the potential benefit of reducing these times, as this may lead to lower revision rates and increased operating volumes. Shorter operation times could be achieved by standardization programs, but one should bear in mind that for cemented implants very short operating times also increased revision risk due to aseptic loosening.

UI MeSH Term Description Entries
D008297 Male Males
D008875 Middle Aged An adult aged 45 - 64 years. Middle Age
D009664 Norway A country located in northern Europe, bordering the North Sea and the Atlantic Ocean, west of Sweden. The capital is Oslo. Kingdom of Norway
D012086 Reoperation A repeat operation for the same condition in the same patient due to disease progression or recurrence, or as followup to failed previous surgery. Revision, Joint,Revision, Surgical,Surgery, Repeat,Surgical Revision,Repeat Surgery,Revision Surgery,Joint Revision,Revision Surgeries,Surgery, Revision
D002484 Cementation The joining of objects by means of a cement (e.g., in fracture fixation, such as in hip arthroplasty for joining of the acetabular component to the femoral component). In dentistry, it is used for the process of attaching parts of a tooth or restorative material to a natural tooth or for the attaching of orthodontic bands to teeth by means of an adhesive. Cementations
D005260 Female Females
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000368 Aged A person 65 years of age or older. For a person older than 79 years, AGED, 80 AND OVER is available. Elderly
D013997 Time Factors Elements of limited time intervals, contributing to particular results or situations. Time Series,Factor, Time,Time Factor
D016896 Treatment Outcome Evaluation undertaken to assess the results or consequences of management and procedures used in combating disease in order to determine the efficacy, effectiveness, safety, and practicability of these interventions in individual cases or series. Rehabilitation Outcome,Treatment Effectiveness,Clinical Effectiveness,Clinical Efficacy,Patient-Relevant Outcome,Treatment Efficacy,Effectiveness, Clinical,Effectiveness, Treatment,Efficacy, Clinical,Efficacy, Treatment,Outcome, Patient-Relevant,Outcome, Rehabilitation,Outcome, Treatment,Outcomes, Patient-Relevant,Patient Relevant Outcome,Patient-Relevant Outcomes

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