Dataset Information

Risk factors for revision of primary total hip replacement: results from a national case-control study.

ABSTRACT: To study the risk factors for revision of primary total hip replacement (THR) in a US population-based sample.Using Medicare claims, we identified beneficiaries from 29 US states who underwent primary THR between July 1, 1995 and June 30, 1996, with followup through December 31, 2008. Potential cases had International Classification of Diseases, Ninth Revision, Clinical Modification codes indicating a revision THR. Each case was matched by state with 1 control THR recipient who was alive and unrevised when the case had a revision THR. We abstracted hospital records to document potential risk factors. We examined the associations between preoperative factors and revision risk using multivariate conditional logistic regression.The analysis data set contained 719 of 836 case-control pairs with complete data for analysis variables. The factors associated with higher revision odds in multivariate models were age ?75 years at primary surgery (odds ratio [OR] 1.52 [95% confidence interval (95% CI) 1.20-1.92]), height in the highest tertile (OR 1.40 [95% CI 1.06-1.85]), weight in the highest tertile (OR 1.66 [95% CI 1.24-2.22]), cemented femoral component (OR 1.44 [95% CI 1.10-1.87]), prior contralateral primary THR (OR 1.36 [95% CI 1.05-1.76]), other prior orthopedic surgery (OR 1.45 [95% CI 1.13-1.84]), and living with others (versus alone; OR 1.26 [95% CI 0.99-1.61]).This first US population-based case-control study of risk factors for revision of primary THR showed that younger, taller, and heavier patients and those receiving a cemented femoral component had a greater likelihood of undergoing a revision THR over a 12-year followup period. Effects of age and body size on revision risk should be addressed by clinicians with patients considering primary THR.

SUBMITTER: Wright EA

PROVIDER: S-EPMC3510659 | biostudies-literature | 2012 Dec

REPOSITORIES: biostudies-literature

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Risk factors for revision of primary total hip replacement: results from a national case-control study.

Wright Elizabeth A EA Katz Jeffrey N JN Baron John A JA Wright R John RJ Malchau Henrik H Mahomed Nizar N Prokopetz Julian J Z JJ Losina Elena E

Arthritis care & research 20121201 12

<h4>Objective</h4>To study the risk factors for revision of primary total hip replacement (THR) in a US population-based sample.<h4>Methods</h4>Using Medicare claims, we identified beneficiaries from 29 US states who underwent primary THR between July 1, 1995 and June 30, 1996, with followup through December 31, 2008. Potential cases had International Classification of Diseases, Ninth Revision, Clinical Modification codes indicating a revision THR. Each case was matched by state with 1 control T ...[more]

PMID: 23193090

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Project description:BackgroundLittle is known about how often patients have revision total hip replacement in the same hospital in which they had the primary procedure.MethodsWe examined Medicare claims data to identify patients who had primary total hip replacement from July 1995 to June 1996 and subsequently had revision through December 31, 2006. We examined whether the revision was performed in the same or different hospital from the primary procedure, with different hospitals being categorized as being in a lower, a higher, or the same hospital volume stratum. Hospital strata included twenty-five or fewer cases of total hip replacement annually in the Medicare population, twenty-six to fifty cases, fifty-one to 100 cases, and >100 cases. We calculated the number of revisions generated (primary procedures eventuating in revision) by hospitals in each volume stratum and the number of revisions performed in these hospitals.ResultsOf 4448 revision procedures, 3306 (74%) were performed in hospitals in the same volume stratum as the hospital where the primary procedure was performed. Four hundred twenty-nine revisions (9.6%) were performed in a lower-volume hospital, and 713 (16%) were performed in a higher-volume hospital. Thirty-one (3%) of 960 patients who had revision within one year after the primary total hip replacement had the revision in a lower-volume center, compared with 204 (15%) of 1393 who had revision more than six years after the primary procedure (odds ratio = 4.6 ; 95% confidence interval, 3.0 to 6.8). The ratio of revisions performed to revisions generated was 1.21 for the highest-volume centers and 0.86 for the lowest-volume centers.ConclusionsOf 4448 revisions examined in this study, 429 (<10%) were performed in centers with a lower volume of total hip replacement than the center at which the initial hip replacement was performed, whereas 713 (16%) were performed in higher-volume centers. Higher-volume centers performed 21% more revisions than they generated (531 revisions performed, compared with 438 generated). These data will help to inform health-care policy with regard to the utilization of resources for revision total hip replacement.

Project description:The number of prosthesis brands used for hip replacement has increased rapidly, but there is little evidence on their effectiveness. We compared patient-reported outcomes, revision rates, and mortality for the three most frequently used brands within each prosthesis type: cemented (Exeter V40 Contemporary, Exeter V40 Duration and Exeter V40 Elite Plus Ogee), cementless (Corail Pinnacle, Accolade Trident, and Taperloc Exceed), and hybrid (Exeter V40 Trilogy, Exeter V40 Trilogy, and CPT Trilogy).We used three national databases of patients who had hip replacements between 2008 and 2011 in the English NHS to compare functional outcome (Oxford Hip Score (OHS) ranging from 0 (worst) to 48 (best)) in 43,524 patients at six months. We analysed revisions and mortality in 187,201 patients. We used multiple regression to adjust for pre-operative differences. Prosthesis type had an impact on post-operative OHS and revision rates (both p<0.001). Patients with hybrid prostheses had the best functional outcome (mean OHS 39.4, 95%CI 39.1 to 39.7) and those with cemented prostheses the worst (37.7, 37.3 to 38.1). Patients with cemented prostheses had the lowest reported 5-year revision rates (1.3%, 1.2% to 1.4%) and those with cementless prostheses the highest (2.2%, 2.1% to 2.4%). Differences in mortality according to prosthesis type were small and not significant (p = 0.06). Functional outcome varied according to brand among cemented (p = 0.05, with Exeter V40 Duration having the best) and cementless prostheses (p = 0.01, with Corail Pinnacle having the best). Revision rates varied according to brand among hybrids (p = 0.05, with Exeter V40 Trident having the lowest).Functional outcomes were better with cementless cups and revision rates were lower with cemented stems, which underlies the good overall performance of hybrids. The hybrid Exeter V40 Trident seemed to produce the best overall results. This brand should be considered as a benchmark in randomised trials.

Project description:PurposeInfection is a major complication following joint replacement (JR) surgery. However, little data exist regarding antibiotic utilisation following primary JR and how use changes with subsequent revision surgery. This study aimed to examine variation in antibiotic utilisation rates before and after hip replacement surgery in those revised for infection, revised for other reasons and those without revision.MethodsThis retrospective cohort analysis used linked data from the Australian Orthopaedic Association National Joint Replacement Registry and Australian Government Pharmaceutical Benefits Scheme. Patients were included if undergoing total hip replacement (THR) for osteoarthritis in private hospitals between 2002 and 2017. Three groups were examined: primary THR with no subsequent revision (n = 102 577), primary THR with a subsequent revision for reasons other than periprosthetic joint infection (PJI) (n = 3156) and primary THR with a subsequent revision for PJI (n = 520). Monthly antibiotic utilisation rates and prevalence rate ratios (PRRs) with 95% confidence intervals (CIs) were calculated in the 2 years pre- and post-THR.ResultsPrior to primary THR antibiotic utilisation was 9%-10%. After primary THR, antibiotic utilisation rates were higher among patients revised for PJI (PRR 1.69, 95% CI 1.60-1.79) compared to non-revised patients, while the utilisation rate was lower in patients revised for reasons other than infection (PRR 0.96, 95% CI 0.93-0.98). For those revised for infection, antibiotic utilisation post-revision surgery was two times higher than those revised for other reasons (PRR 2.16, 95% CI 2.08-2.23). Utilisation of injectable antibiotics including, vancomycin, flucloxacillin and cephazolin was higher in those revised for PJI patients 0-2 weeks following surgery but not in those revised for other reasons compared to the non-revised group.ConclusionsOngoing antibiotic utilisation after primary surgery may be an early signal of problems with the THR and should be a prompt for primary care physicians to refer patients to specialists for further appropriate investigations and management.

Project description:BackgroundDislocation following total hip replacement (THR) is associated with repeated hospitalisations and substantial costs to the health system. Factors influencing dislocation following primary THR are not well understood. We aimed to assess the associations of patient-, surgery-, implant- and hospital-related factors with dislocation risk following primary THR.MethodsWe did a systematic review and meta-analysis of all longitudinal studies reporting these associations. We searched MEDLINE, Embase, Web of Science, and Cochrane Library to March 8, 2019. Summary measures of association were calculated using relative risks (RRs) (with 95% confidence intervals, CIs). The review is registered on PROSPERO, number CRD42019121378.FindingsWe identified 149 articles based on 125 unique studies with data on 4 633 935 primary THRs and 35 264 dislocations. The incidence rates of dislocation ranged from 0·12% to 16·13%, with an overall pooled rate of 2·10% (1·83-2·38) over a weighted mean follow-up duration of 6 years. Using median year of data collection, there was a significant decline in dislocation rates from 1971 to 2015. Comparing males vs females, age ≥70 vs <70 years, and high vs low income, RRs (95% CIs) for dislocation were 0·97 (0·88-1·08), 1·27 (1·02-1·57), and 0·79 (0·74-0·85) respectively. White ethnicity, drug use disorder, and social deprivation were each associated with an increased dislocation risk. Comparing body mass index (BMI) ≥30 vs. <30 kg/m2, the RR (95% CI) for dislocation was 1·38 (1·03-1·85). Medical and surgical history-related factors associated with dislocation risk included neurological disorder, psychiatric disease, comorbidity indices, previous surgery including spinal fusion, and surgical indications including avascular necrosis, rheumatoid arthritis, inflammatory arthritis, and osteonecrosis. Surgical factors such as the anterolateral, direct anterior, or lateral approach and posterior with short external rotator and capsule repair were each associated with reduced dislocation risk. At the implant level, larger femoral head diameters, elevated acetabular liners, dual mobility cups, cemented fixations and standard femoral neck lengths reduced the risk of dislocation. Hospital-related factors such as experienced surgeons and high surgeon procedure volume each reduced the risk of dislocation.InterpretationDislocation following primary THR is on a temporal decline. Surgical approaches that reduce dislocation risk can be used by clinicians when performing primary THR. Alternative bearings such as dual mobility can be used in individuals at high risk of dislocation. Modifiable risk factors such as high BMI and comorbidities may be amenable to optimisation prior to surgery.FundingNational Institute for Health Research.

Dataset Information

Risk factors for revision of primary total hip replacement: results from a national case-control study.

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Risk factors for revision of primary total hip replacement: results from a national case-control study.

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