A Trend for Increased Risk of Revision Surgery due toDeep Infection following Fast-Track Hip Arthroplasty

Rates of revision surgery due to deep infection following total hip arthroplasty (THA) increased at a Norwegian hospital followingimplementation of fast-track procedures. The purpose of this study was to determine whether selected demographic (age and sex)and clinical (body mass index, American Society of Anesthesiologists(ASA) classification, surgery duration, length of hospital stay,cemented versus uncemented prosthesis, and fast-track procedures) factors were associated with higher risk of revision surgerydue to deep infection following THA. In a prospective designed study 4,406 patients undergoing primary THA between January2001 and January 2013 where included. Rates of infection-related revision surgery within 3 months of THA were higher amongmales and among patients who received fast-track THA. Adjusting for sex and age, the implemented fast-track elements weresignificantly associated with increased risk of revision surgery. Risk of infection-related revision surgery was unrelated to bodymass index, physical status, surgery duration, length of hospital stay, and prosthesis type. Because local infiltration analgesia, draincessation, and early mobilization were introduced in combination, it could not be determined which component or combination ofcomponents imposed the increased risk. The findings in this small sample raise concern about fast-track THA but require replicationin other samples.