German Congress of Orthopaedics and Traumatology (DKOU 2025)
Perioperative management and clinical outcome of LVAD patients undergoing THA: A retrospective case series of 11 patients
2German Heart Center, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Deutschland
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Objectives and questions: Left ventricular assist devices (LVADs) are commonly utilized in severe left-sided heart disease as a bridge to transplantation or long-term treatment. Total hip arthroplasty (THA) improves mobility in these patients but entails numerous perioperative risks. Our study focused on perioperative management and clinical outcomes for LVAD patients undergoing THA, aiming to provide insights into this complex setting.
Material and methods: We retrospectively analyzed patients with LVADs who underwent THA at our institution from May 2019 to November 2023. The outcomes of interest were perioperative anticoagulation management, thrombotic or bleeding events, transfusion needs, mortality, surgical site complications and reoperations. The functional outcome was evaluated using the modified Harris Hip Score (mHHS) and the EQ-5D quality of life score at their last follow-up.
Results: The cohort consisted of 11 male patients, mean age 68.1 years. Patient survival was recorded over a 22.8-month mean follow-up (range, 1 to 53). Seven patients (63.6%) required postoperative transfusions and 5/11 patients (45.5%) experienced thromboembolic events. The mean hospital stay after THA was 13.5 days. The overall mortality related-to-disease rate in our series of LVAD patients undergoing primary THA was 27%. Three patients (27.3%) developed surgical site hematomas, which required one additional reoperation，one of those was infected. Hip functionality improved markedly, with the mean mHHS rising from 27.5 to 72.3.
Discussion and conclusions: THA in LVAD patients is challenging yet feasible, offering significant functional improvements despite the increased perioperative morbidity. Mortality was associated with their underlying disease, but not the surgery.
