The main causes of deaths in hip arthroplasty in the long term after surgery

Total hip arthroplasty is currently the treatment of choice for end-stage hip osteoarthritis. However, joint replacement with an implant is often associated with the development of intraoperative and postoperative complications, and fatal outcomes following total hip arthroplasty are not uncommon. Objective – to analyze the incidence and structure of mortality at various time points after total hip arthroplasty using conventional statistical methods and the Kaplan – Meier method. The study included 507 patients aged 19 to 87 years who underwent total hip arthroplasty at the Department of Traumatology and Orthopedics of North-Western State Medical University named after I.I. Mechnikov between 2015 and 2018. The data were processed using Microsoft Excel and the R software environment. Long-term outcomes and patient survival after total hip arthroplasty were evaluated using the non-parametric Kaplan – Meier method. Among the 233 patients (46.0 % of the total cohort) who remained under observation for 7 to 10 years after total hip arthroplasty, the mortality rate was 36 cases (15.5 %). The highest number of deaths was recorded in the first year following surgery (4.29 %), with a gradual decline to 0.43 % by the eighth year. The leading causes of death were acute myocardial infarction and acute cerebrovascular accident (each accounting for 27.8 % of cases), followed by malignant neoplasms and COVID19 (each 13.9 %), and pulmonary embolism (11.1 %). The Kaplan – Meier analysis, which takes into account information on censored observations, shows mortality rates of 8.9 % for 8–10 years after total hip arthroplasty, while 7.4 % of patients died in the first five years after hip arthroplasty. Most deaths occurred within the first five years after surgery, consistent with the literature. A significant limitation of the study was the high proportion of patients lost to follow-up, which limited the completeness of long-term outcome evaluation and underscores the need for unified registries and postoperative monitoring systems. Long-term outcomes of total hip arthroplasty show a high mortality rate. Mortality indicators vary depending on the statistical analysis method used. The most objective results are obtained through registry-based analysis, which confirms the need for organized long-term follow-up of patients after surgery.

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