Admission Lymphocyte-to-C-Reactive Protein Ratio Predicts 90-Day Adverse Outcomes Following Aseptic Revision Total Hip Arthroplasty.

Abstract

Revision total hip arthroplasty (rTHA) is linked to a greater risk of adverse postoperative outcomes in comparison to primary total hip arthroplasty (THA), owing to heightened surgical complexity and the burden of patient comorbidities. Consequently, there is an imperative need for an easily accessible predictor to facilitate preoperative risk stratification prior to rTHA. This study was conducted to evaluate the predictive utility of the admission lymphocyte-to-C-reactive protein ratio (LCR) concerning adverse events within 90 days postoperatively following aseptic revision total hip arthroplasty (rTHA). A retrospective cohort analysis was conducted involving 5,596 patients who underwent aseptic rTHA from 2010 to 2022 at a tertiary arthroplasty center. Patient demographics, clinical parameters, and perioperative data were collected. Adverse outcomes within 90 days postoperatively, including major and minor complications, unplanned readmissions, and mortality, were analyzed. Logistic regression analysis was performed to estimate the predictive value of preoperative LCR in conjunction with other potential risk factors, while receiver operating characteristic (ROC) curve analysis was utilized to establish the most appropriate LCR cut-off values. A total of 716 patients (12.8%) experienced postoperative adverse events. The admission LCR was significantly lower among these patients compared to controls. Multivariate analysis revealed that a reduced preoperative LCR was strongly associated with increased risk of major complications (odds ratio [OR] 22.6, 95% confidence interval [CI] 14.45 to 35.36; P < 0.001), minor complications (OR 1.89, 95% CI 1.39 to 2.23, P = 0.002), unplanned readmissions (OR 2.14, 95% CI 1.49 to 3.14, P < 0.001), and mortality (OR 4.89, 95% CI 3.74 to 6.58, P < 0.001). The ROC analysis identified an optimal LCR cut-off value of 2.71, with an area under the curve of 0.93, sensitivity of 87.1%, and specificity of 95.7% for predicting adverse outcomes. Admission LCR serves as a potent, cost-effective biomarker for predicting 90-day adverse events following aseptic rTHA. Preoperative assessment of LCR can significantly enhance risk stratification, informing clinical decisions and optimizing postoperative care. Further prospective research is necessary to validate these findings and elucidate the underlying pathophysiological mechanisms.