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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    • "The incidence is approximately 1% after primary cases and about 4% in revision cases, despite strict antiseptic operative procedures which include systemic prophylaxis [2] [3]. Currently, PJI is the second or third most common cause for revision hip arthroplasty [4] [5]. Postoperative PJIs are thought to be the result of bacterial adhesion to the implant surface and subsequent biofilm formation at the implantation site. "
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    ABSTRACT: We developed a new povidone iodine coating technology for titanium hip implants and performed a clinical trial to assess its usefulness in suppressing postoperative infection. Results indicate that iodine-supported titanium has favorable antibacterial activity, biocompatibility, and no cytotoxicity. Thirty joints in 28 patients were treated using iodine-supported implants. Fourteen joints were revision total hip arthroplasty (THA) after periprosthetic infection, 13 were primary THA for immunosuppressive conditions or pyogenic arthritis, and 3 were conversions from hemiarthroplasty to THA for immunosuppressive conditions. Two examinations were conducted sequentially until final follow-up: white blood cell (WBC) and C-reactive protein (CRP) were measured pre- and postoperatively and thyroid hormone levels in the blood were examined. The mean follow-up period was 33 months (14–78). There were no signs of infection in any patient at the last follow-up. WBC and CRP levels returned to normal within several weeks. No abnormalities of thyroid gland function were detected. Loosening of the implants did not occur in any patient. Excellent bone ingrowth and ongrowth were found around prostheses. No cytotoxicity or adverse effects were detected. These results suggest that iodine-supported THA implants can be highly effective in preventing and treating postoperative infections.
    11/2015; 2015:1-6. DOI:10.1155/2015/368124
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    • "In the 'Finnish Arthroplasty Register', between 1980 and 1999, 12,224 revision hip arthroplasties were recorded and there are almost 40,000 revision total hip arthroplasties (THAs) performed annually in the United States. This number has steadily increased over the past 20 years, and is expected to continue to increase over the next several decades [3]. Failures of hip prosthesis have been reported due to fatigue failure of hip joint stem [4] [5], fracture of bone cement [6] and wear caused by sliding present between head and socket [7]. "
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    International Conferrence on Modelling, Simulation and Control (ICMSC- 2015), coimbatore; 10/2015
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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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    BioMed Research International 11/2014; 2015(1). DOI:10.1155/2015/625317 · 1.58 Impact Factor
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