Hospital Cost of Treating Early Dislocation following Hip Arthroplasty

Palma, Luigi de; Procaccini, Roberto; Soccetti, A; Marinelli, Massimiliano

doi:10.5301/hip.2012.9059

Cited by 47 publications

(30 citation statements)

References 20 publications

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“…[2][3][4][5] Such findings have implications for the centralization of delivery of arthroplasty, 6 particularly as these complications are associated with considerable morbidity and increased healthcare costs. [7][8][9][10] There is, however, a lack of consensus around what constitutes a "low" annual volume, with definitions ranging from less than six to less than 52 procedures a year. [11][12][13] The lack of a consistent definition is a reflection of the fact that volume thresholds have typically been created to ensure an even distribution of patients across volume categories.…”

Section: Introductionmentioning

confidence: 99%

Relation between surgeon volume and risk of complications after total hip arthroplasty: propensity score matched cohort study

Ravi

Jenkinson

Austin

et al. 2014

BMJ

229

160

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Objectives To identify a cut point in annual surgeon volume associated with increased risk of complications after primary elective total hip arthroplasty and to quantify any risk identified.Design Propensity score matched cohort study. Setting Ontario, CanadaParticipants 37 881 people who received their first primary total hip arthroplasty during 2002-09 and were followed for at least two years after their surgery.Main outcome measure The rates of various surgical complications within 90 days (venous thromboembolism, death) and within two years (infection, dislocation, periprosthetic fracture, revision) of surgery.Results Multivariate splines were developed to visualize the relation between surgeon volume and the risk for various complications. A threshold of 35 cases a year was identified, under which there was an increased risk of dislocation and revision. 6716 patients whose total hip arthroplasty was carried out by surgeons who had done ≤35 such procedure in the previous year were successfully matched to patients whose surgeon had carried out more than 35 procedures. Patients in the former group had higher rates of dislocation (1.9% v 1.3%, P=0.006; NNH 172) and revision (1.5% v 1.0%, P=0.03; NNH 204).Conclusions In a cohort of first time recipients of total hip arthroplasty, patients whose operation was carried by surgeons who had performed 35 or fewer such procedures in the year before the index procedure were at increased risk for dislocation and early revision. Surgeons should consider performing 35 cases or more a year to minimize the risk for complications. Furthermore, the methods used to visualize the relationship between surgeon volume and the occurrence of complications can be easily applied in any jurisdiction, to help inform and optimize local healthcare delivery.

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Section: Introductionmentioning

confidence: 99%

Relation between surgeon volume and risk of complications after total hip arthroplasty: propensity score matched cohort study

Ravi

Jenkinson

Austin

et al. 2014

BMJ

229

160

View full text Add to dashboard Cite

show abstract

“…Confirmation of these findings is important. In addition to the significant morbidity associated with these complications (16,17), if joint replacement recipients with RA are found to be at greater risk of surgical complications, this may have implications for surgical decision-making. The current study sought to overcome the limitations of prior studies.…”

mentioning

confidence: 99%

Increased Risk of Complications Following Total Joint Arthroplasty in Patients With Rheumatoid Arthritis

Ravi

Croxford

Hollands

et al. 2014

Arthritis & Rheumatology

170

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Objective. Most of the evidence regarding complications following total hip arthroplasty (THA) and total knee arthroplasty (TKA) are based on patients with osteoarthritis (OA); less is known about outcomes in rheumatoid arthritis (RA). Using a validated algorithm for identifying patients with RA, we undertook this study to compare the rates of complications among THA and TKA recipients between those with RA and those without RA.Methods. In patients who underwent a first primary elective THA or TKA between 2002 and 2009, those with RA were identified using a validated algorithm: a hospitalization with a diagnosis code for RA or 3 physician billing claims with a diagnosis code for RA, with at least 1 claim by a specialist (rheumatologist, orthopedic surgeon, or internist) in a 2-year period. Recipients with diagnostic codes suggesting an inflammatory arthritis, but not meeting RA criteria, were classified as having inflammatory arthritis. All remaining patients were deemed to have OA. Cox proportional hazards models, censored on death, were used to determine the relationship between the type of arthritis and the occurrence of specific complications, adjusting for potential confounders (age, sex, comorbidity, and provider volume).Results. We identified 43,997 eligible THA recipients (3% with RA) and 71,793 eligible TKA recipients (4% with RA). Total joint arthroplasty recipients with RA had higher age and sex-standardized rates of dislocation following THA (2.45%, compared with 1.21% for recipients with OA) and higher age and sex-standardized rates of infection following TKA (1.26%, compared with 0.84% for recipients with OA). Controlling for potential confounders, recipients with RA remained at increased risk of dislocation within 2 years of THA (adjusted hazard ratio [HR] 1.91, P ‫؍‬ 0.001) and remained at increased risk of infection within 2 years of TKA (adjusted HR 1.47, P ‫؍‬ 0.03) relative to recipients with OA.Conclusion. Patients with RA are at higher risk of dislocation following THA and are at higher risk of infection following TKA relative to those with OA. Further research is warranted to elucidate explanations for these findings, including the roles of medication profile, implant choice, postoperative antibiotic protocol, and method of rehabilitation following joint replacement.

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“…2 DaPalma et al analysed the financial impact of complications following hip arthroplasty and found the additional cost of a dislocation within six weeks of surgery is 342% of the primary cost. 3 …”

Section: Introductionmentioning

confidence: 99%

Computer navigation of the acetabular component in total hip arthroplasty: a narrative review

Davenport

Kavarthapu

2016

EFORT Open Reviews

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Total hip arthroplasty (THA) is a common procedure for primary osteoarthritis, but increasing numbers are also being performed for other pathologies such as secondary arthritis, inflammatory arthropathies and trauma. Estimates suggest that around 8.5 million people in the UK are affected by joint pain secondary to arthritis and a rising ageing population has resulted in an increase in THA operations of around 4% per year over the last six years.Multiple studies have shown that THA provides improved quality of life scores, but there remains the burden of complications which account for 15% of £1bn NHS liability payouts. DaPalma et al analysed the financial impact of complications following THA and found the additional cost of a dislocation within six weeks of surgery is 342% of the primary cost.Following primary THA, complications may occur as a result of incorrect component positioning of the femoral stem, the acetabular cup or both. It is known that acetabular malposition may lead to increased rates of dislocation, impingement, edge-loading, polyethylene wear, pelvic osteolysis and prosthesis failure.Acetabular component positioning has been described as the single most important factor in dictating risk of dislocation following THA. Furthermore, instability and dislocation after primary THA is the most common single reason for revision surgery accounting for 22.5% of all revisions and 33% of acetabular revisions.We outline the currently available methods of acetabular navigation comparing freehand techniques with computer and robotic-assisted navigation of the acetabular component.Cite this article: Davenport D, Kavarthapu V. Computer navigation of the acetabular component in total hip arthroplasty: a narrative review. EFORT Open Rev 2016;1:279-285. DOI: 10.1302/2058-5241.1.000050.

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Hospital Cost of Treating Early Dislocation following Hip Arthroplasty

Cited by 47 publications

References 20 publications

Relation between surgeon volume and risk of complications after total hip arthroplasty: propensity score matched cohort study

Relation between surgeon volume and risk of complications after total hip arthroplasty: propensity score matched cohort study

Increased Risk of Complications Following Total Joint Arthroplasty in Patients With Rheumatoid Arthritis

Computer navigation of the acetabular component in total hip arthroplasty: a narrative review

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