The Epidemiology of Revision Total Hip Arthroplasty in the United States

Department of Orthopaedic Surgery and Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, 500 Parnassus Avenue, MU 320W, San Francisco, CA 94143-0278, USA.
The Journal of Bone and Joint Surgery (Impact Factor: 5.28). 02/2009; 91(1):128-33. DOI: 10.1016/j.arth.2008.11.033
Source: PubMed


Understanding the causes of failure and the types of revision total hip arthroplasty performed is essential for guiding research, implant design, clinical decision-making, and health-care policy. The purpose of the present study was to evaluate the mechanisms of failure and the types of revision total hip arthroplasty procedures performed in the United States with use of newly implemented ICD-9-CM (International Classification of Diseases, Ninth Revision, Clinical Modification) diagnosis and procedure codes related specifically to revision total hip arthroplasty in a large, nationally representative population.
The Healthcare Cost and Utilization Project Nationwide Inpatient Sample database was used to analyze clinical, demographic, and economic data from 51,345 revision total hip arthroplasty procedures performed between October 1, 2005, and December 31, 2006. The prevalence of revision procedures was calculated for population subgroups in the United States that were stratified according to age, sex, diagnosis, census region, primary payer class, and type of hospital. The cause of failure, the average length of stay, and total charges were also determined for each type of revision arthroplasty procedure.
The most common type of revision total hip arthroplasty procedure performed was all-component revision (41.1%), and the most common causes of revision were instability/dislocation (22.5%), mechanical loosening (19.7%), and infection (14.8%). Revision total hip arthroplasty procedures were most commonly performed in large, urban, nonteaching hospitals for Medicare patients seventy-five to eighty-four years of age. The average length of hospital stay for all types of revision arthroplasties was 6.2 days, and the average total charges were $54,553. However, the average length of stay, average charges, and procedure frequencies varied considerably according to census region, hospital type, and type of revision total hip arthroplasty procedure performed.
Hip instability and mechanical loosening are the most common indications for revision total hip arthroplasty in the United States. As further experience is gained with the new diagnosis and procedure codes specifically related to revision total hip arthroplasty, this information will be valuable in directing future research, implant design, and clinical decision-making.

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Available from: Edmund Lau, Jan 22, 2014
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    • "Total hip replacement (THR) is one of the most successful operations of the 20th century [1]. Instability and early aseptic loosening are the two most common early complications following THR [2] [3] [4] [5]. Biomathematical calculations have shown that prosthetic instability can be reduced by regarding stem and cup as coupled partners in a biomechanical system [6]. "
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    ABSTRACT: We have developed a novel, computer-assisted operation method for minimal-invasive total hip replacement (THR) following the concept of “femur first/combined anteversion,” which incorporates various aspects of performing a functional optimization of the prosthetic stem and cup position (CAS FF). The purpose of this study is to assess whether the hip joint reaction forces and patient’s gait parameters are being improved by CAS FF in relation to conventional THR (CON). We enrolled 60 patients (28 CAS FF/32 CON) and invited them for gait analysis at three time points (preoperatively, postop six months, and postop 12 months). Data retrieved from gait analysis was processed using patient-specific musculoskeletal models. The target parameters were hip reaction force magnitude (hrf), symmetries, and orientation with respect to the cup. Hrf in the CAS FF group were closer to a young healthy normal. Phase-shift symmetry showed an increase in the CAS FF group. Hrf orientation in the CAS FF group was closer to optimum, though no edge or rim-loading occurred in the CON group as well. The CAS FF group showed an improved hrf orientation in an early stage and a trend to an improved long-term outcome.
    BioMed Research International 11/2014; · 3.17 Impact Factor
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    • "Malgré l'amélioration des techniques , des voies d'abord, des matériaux et du dessin des implants, la durée de vie des PTH reste limitée avec un taux de reprises de PTH (rePTH) qui augmente régulièrement [2]. Les registres nationaux rapportent que les causes de rePTH (à l'exclusion des reprises itératives ) sont par ordre de fréquence décroissante : le descellement aseptique, l'instabilité, l'infection, la fracture péri-prothétique et la douleur [3] [4] [5] [6] [7] [8]. Pour pallier l'absence de registre national, la Société franç aise de chirurgie orthopédique et de traumatologie (SoFCOT) a lancé en 2009 une étude prospective analysant l'épidémiologie des premières rePTH afin d'évaluer les causes de faillite des PTH primaires [9]. "
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    ABSTRACT: La reprise des prothèses totales de hanche (rePTH) pour fracture péri-prothétique (FPP) est de plus en plus fréquente, mais elle demeure la quatrième cause de révision dans les registres et sa place par rapport aux autres indications de révision n’est pas connue en France du fait de l’absence de registre. Les objectifs de ce travail étaient de préciser : (1) la fréquence relative de cette cause de reprise ; (2) le terrain de survenue et le type de PTH primaire ; (3) les modalités de révision ; (4) la morbi-mortalité de ces interventions.
    Revue de Chirurgie Orthopédique et Traumatologique 10/2014; 100(6):485–490. DOI:10.1016/j.rcot.2014.03.043
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    • "In particular, there is a corresponding increase in the number of orthopedic-device failures related to infection.3 Among the various causes, failure due to infection, also known as “septic failure,” is the most common cause for revision surgeries in total knee arthroplasties (25%), the third most common cause in all total hip arthroplasties (15%), and the most common reason for the removal of all total knee arthroplasties and total hip arthroplasties (79% and 74%, respectively), while costing about US$70,000 per episode.4–6 These statistics highlight the difficulty in treating orthopedic-implant and other medical-device infections using today’s pharmaceutical approaches. "
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    ABSTRACT: Plasma-spray deposition of hydroxyapatite on titanium (Ti) has proven to be a suboptimal solution to improve orthopedic-implant success rates, as demonstrated by the increasing number of orthopedic revision surgeries due to infection, implant loosening, and a myriad of other reasons. This could be in part due to the high heat involved during plasma-spray deposition, which significantly increases hydroxyapatite crystal growth into the nonbiologically inspired micron regime. There has been a push to create nanotopographies on implant surfaces to mimic the physiological nanostructure of native bone and, thus, improve osteoblast (bone-forming cell) functions and inhibit bacteria functions. Among the several techniques that have been adopted to develop nanocoatings, electrophoretic deposition (EPD) is an attractive, versatile, and effective material-processing technique. The in vitro study reported here aimed to determine for the first time bacteria responses to hydroxyapatite coated on Ti via EPD. There were six and three times more osteoblasts on the electrophoretic-deposited hydroxyapatite on Ti compared with Ti (control) and plasma-spray-deposited hydroxyapatite on Ti after 5 days of culture, respectively. Impressively, there were 2.9 and 31.7 times less Staphylococcus aureus on electrophoretic-deposited hydroxyapatite on Ti compared with Ti (control) and plasma-spray-deposited hydroxyapatite on Ti after 18 hours of culture, respectively. Compared with uncoated Ti and plasma-sprayed hydroxyapatite coated on Ti, the results provided significant promise for the use of EPD to improve bone-cell density and be used as an antibacterial coating without resorting to the use of antibiotics.
    International Journal of Nanomedicine 04/2014; 9(1):1775-81. DOI:10.2147/IJN.S55733 · 4.38 Impact Factor
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