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Patients aged 45-64 years may have higher THA revision rate
Despite a significant increase in the revision rate of total hip arthroplasties performed in patients between aged 45 years to 64 years , results published in The Journal of Bone and Joint Surgery also showed a significant decrease in the rate of surgically treated total hip arthroplasty dislocations.
Among 320,496 THA revisions identified between 2007 and 2013 from the Nationwide Inpatient Sample, data showed patients aged 45 years to 64 years had an increased THA revision rate of 30.4%, adjusted for U.S. population growth.
“We identified a 12% increase in the overall estimated THA revision rate over 6 years, adjusting for population growth,” Sean S. Rajaee MD, co-author of the study, told Healio.com/Orthopedics. “Interestingly, this increase was driven primarily by patients aged 45 -64 years, which increased by 30% while all other groups saw a decrease in the revision rate.”
However, researchers found a 14.3% decrease in the rate of surgically treated THA dislocations between 2007 to 2013.
“This gain was offset by an increase in revision surgery due to ‘other mechanical complications’”, Rajaee said. “We believe this trend likely reflects complications related to the increased use of ‘metal-on-metal’ hip implants during that time.”
Compared with 2007, researchers noted a significantly lower mean length of hospital stay and hospital costs for THA revision in 2013.
According to a multivariable model, patients had a significantly lower odd for experiencing deep vein thrombosis, pulmonary embolism, myocardial infarction, transfusion, pneumonia, urinary tract infection and mortality after revision THA in 2013 vs. 2007. Researchers also found a lower odd for discharge to a skilled nursing facility in 2013. – by Casey Tingle
Disclosure: The authors report no relevant financial disclosures.
Perspective
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The authors have done a nice job reviewing the burden of revision total hip replacement surgery. This study, however, has the same challenges of any large retrospective database studies in that the reader is almost always left wanting more. For instance, what was the average time to revision from primary? Has this changed over time? That being said, there is no doubt that this article clearly points out further economic challenges of an increasing burden of revision hip surgery, a procedure that challenges hospital finances.