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Increasing Burden of Total Hip Arthroplasty Revisions in Patients Between 45 and 64 Years of Age

Rajaee, Sean S., MD1,a; Campbell, Joshua C., MD1; Mirocha, James, MS1; Paiement, Guy D., MD1

doi: 10.2106/JBJS.17.00470
Scientific Articles

Background: This study provides a comprehensive analysis of total hip arthroplasty (THA) revisions in the U.S. from 2007 to 2013.

Methods: International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes were used to identify all THA revisions in the Nationwide Inpatient Sample (NIS) from 2007 to 2013. The diagnoses leading to the revisions, types of revisions, major inpatient complications, and hospital and patient characteristics were compared between 2007 and 2013. Multivariable logistic regression models were used to calculate adjusted odds ratios (ORs) for complications in 2013 versus 2007.

Results: This study identified 320,496 THA revisions performed between 2007 and 2013. From 2007 to 2013, the THA revision rate adjusted for U.S. population growth increased by 30.4% in patients between 45 and 64 years of age and decreased in all other age groups. The rate of surgically treated THA dislocations decreased by 14.3% from 2007 to 2013 (p < 0.0001). The mean length of the hospital stay and hospital costs for THA revision were significantly lower in 2013 than in 2007 (4.6 versus 5.8 days and $20,463 versus $25,401 both p < 0.0001). A multivariable model showed that the odds of a patient undergoing THA revision having the following inpatient complications were significantly lower in 2013 than in 2007: deep vein thrombosis (OR = 0.57, p = 0.004), pulmonary embolism (OR = 0.45, p = 0.047), myocardial infarction (OR = 0.52, p = 0.003), transfusion (OR = 0.64, p < 0.0001), pneumonia (OR = 0.56, p < 0.0001), urinary tract infection (OR = 0.66, p < 0.0001), and mortality (OR = 0.50, p = 0.0009). Notably, the odds of being discharged to a skilled nursing facility were also lower in 2013 than in 2007 (OR = 0.71, p < 0.0001).

Conclusions: The THA revision rate has significantly increased in patients between 45 and 64 years of age. However, the rate of surgically treated THA dislocations has decreased significantly. This may indicate that evolving techniques and implants are improving stability. The rate of inpatient complications following THA revision also decreased significantly from 2007 to 2013.

Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

1Department of Orthopaedic Surgery (S.S.R., J.C.C., and G.D.P.) and Biostatistics & Bioinformatics Research Center (J.M.), Cedars-Sinai Medical Center, Los Angeles, California

aE-mail address for S.S. Rajaee:

Copyright © 2018 by The Journal of Bone and Joint Surgery, Incorporated
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