Population-Based Rates of Revision of Primary Total Hip Arthroplasty: A Systematic Review

Introduction Advances in surgical technique, implant design, and clinical care pathways have resulted in higher expectations for improved clinical outcomes after primary THA; however, despite these advances, it is unclear whether the risk of revision THA actually has decreased with time. Understanding trends in short-and mid-term risks of revision will be helpful in directing clinical, research, and policy efforts to improve THA outcomes.Question/purposes We therefore asked (1) whether there have been changes in overall short-and mid-term risks of revision THA among patients in the Medicare population who underwent primary THA between 1998 and 2010; and (2) whether there are different demographic factors associated with short-and mid-term risks of revision THA. Methods Using the Medicare 5% national sample database, patients who underwent primary THA between 1998 and 2010 followed by subsequent revision through 2011

Section: Discussioncontrasting

confidence: 67%

Section: Discussionmentioning

confidence: 99%

Short-term Risk of Revision THA in the Medicare Population Has Not Improved With Time

Bozic

Ong

Kurtz

et al. 2016

“…The revision TKAs were mostly attributable to mechanical loosening and periprosthetic joint infection in younger patients (younger than 75 years), which may represent an emerging age shift, given that an increasing proportion of primary TKAs are being performed in younger patients [18,58]. The similar patient age trends in revision THA also may represent an emerging age shift in the burden of revision, given that an increasing proportion of primary THAs are being performed in younger patients [11,19,23,42,44]. It is estimated that by 2030, patients younger than 65 years will comprise 52% of primary THAs being performed [23].…”

Section: Discussionmentioning

confidence: 98%

“…The etiology of the increase in the number of revision procedures is multifactorial. The increasing absolute number of primary arthroplasties [21,44,53,58], expansion of the indications to include younger and more active individuals [11,18,19,23,29,30,34,42,44,46,49], and certain patient factors such as obesity [55,60], all likely contribute to overall revision rates. Projections based on population studies point to continued increases in the prevalence of revision procedures [22].…”

Section: Introductionmentioning

confidence: 99%

Comparative Epidemiology of Revision Arthroplasty: Failed THA Poses Greater Clinical and Economic Burdens Than Failed TKA

Bozic

Kamath

Ong

et al. 2015

399

235

Background Revision THA and TKA are growing and important clinical and economic challenges. Healthcare systems tend to combine revision joint replacement procedures into a single service line, and differences between revision THA and revision TKA remain incompletely characterized. These differences carry implications for guiding care and resource allocation. We therefore evaluated epidemiologic trends associated with revision THAs and TKAs. Questions/purposes We sought to determine differences in (1) the number of patients undergoing revision TKA and THA and respective demographic trends; (2) differences in the indications for and types of revision TKA and THA; (3) differences in patient severity of illness scoring between THA and TKA; and (4) differences in resource utilization (including cost and length of stay [LOS]) between revision THA and TKA. Methods The Nationwide Inpatient Sample (NIS) was used to evaluate 235,857 revision THAs and 301,718 revision TKAs between October 1, 2005 and December 31, 2010. Patient characteristics, procedure information, and resource utilization were compared across revision THAs and TKAs. A revision burden (ratio of number of revisions to total number of revision and primary surgeries) was calculated for hip and knee procedures. Severity of illness scoring and cost calculations were derived from the NIS. As our study was principally descriptive, statistical analyses generally were not performed; however, owing to the large sample size available to us through this NIS analysis, even small observed differences presented are likely to be highly statistically significant.One or more of the authors (SMK, KO, EL) are employees of Exponent, Inc, Menlo Park, CA, USA, and Philadelphia, PA, USA. One of the authors certifies that he (DJB), or a member of his or her immediate family, has received or may receive payments or benefits, during the study period, an amount in excess of USD 100,001-USD 1,000,000, from DePuy Orthopaedics, Inc (Warsaw, IN, USA). One of the authors (TPV) certifies that he has received or may receive payments or benefits, during the study period, an amount in excess of USD 10,001-USD 100,000 from DePuy Orthopaedics, Inc (Warsaw, IN, USA). One of the authors (HER) certifies that he has received or may receive payments or benefits, during the study period, an amount in excess of USD 100,001-USD 1,000,000, from Zimmer, Inc (Warsaw, IN, USA Clin Orthop Relat Res (2015) 473:2131-2138 DOI 10.1007/s11999-014-4078-8 Clinical Orthopaedics and Related Research ® A Publication of The Association of Bone and Joint Surgeons®Results Revision TKAs increased by 39% (revision burden, 9.1%-9.6%) and THAs increased by 23% (revision burden, 15.4%-14.6%). Revision THAs were performed more often in older patients compared with revision TKAs. Periprosthetic joint infection (25%) and mechanical loosening (19%) were the most common reasons for revision TKA compared with dislocation (22%) and mechanical loosening (20%) for revision THA. Full (all-component) revision was more common i...

“…The potential for biological fixation as well as extensive marketing and excellent outcomes in single-center studies of cementless femoral components may account for the increasing worldwide use of cementless fixation [16]. Such increased use of cementless components might be considered paradoxical because some registry data suggest inferior survival of cementless THA [7,19,21,27].…”

Section: Introductionmentioning

confidence: 99%

Do Rerevision Rates Differ After First-time Revision of Primary THA With a Cemented and Cementless Femoral Component?

Gromov

Pedersen

Overgaard

et al. 2015

Background Worldwide use of cementless fixation for total hip arthroplasty (THA) is on the rise despite some evidence from the world's registries suggesting inferior survivorship compared with cemented techniques. The patterns of bone loss associated with failed cementless and cemented THAs may prejudice the results of future revision procedures; however, this has not been documented. Questions/purposes The purpose of this study was to compare (1) the risk for rerevision of first revision THA; (2) the patterns of femoral bone loss at the time of first revision of primary THA; (3) the reasons for first revision of primary THA; and (4) the time to first revision of primary THA between primary cementless and cemented femoral components. Methods Primary THAs with cemented (n = 1791) and uncemented (n = 805) femoral components that subsequently sustained first revision of the femoral component were identified from the Danish Hip Arthroplasty Registry (DHR). As of 2012, 120,988 primary THAs and 19,282 revisions were registered in the DHR with completeness of 97% and 90% for primary and revision THA, respectively. Median followup for revisions of primary THA with cemented and cementless femoral component was 4 years (range, 0-17 years) and 2 years (range, 0-16 years), respectively. Survival of first revision THA, with second revision of the femur as outcome, was evaluated using hazard ratios (HRs) with 95% confidence interval (CI) adjusting for potential confounding. All patient-and surgery-related data are collected from Danish medical databases. Recording of bone defects in the DHR is based on surgeons' intraoperative findings. Results With the numbers studied, we found no differences in the risk of second revision between the overall cohort between cementless and cemented techniques (HR, 1.32; 95% CI, 0.97-1.80; p = 0.076); however, a second revision for Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research 1 editors and board members are on file with the publication and can be viewed on request. Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained. Conclusions We found no differences in the risk of second revision in the overall cohort between cementless and cemented techniques; however, we observed an increased risk for rerevision THA performed on patients \ 70 years whose index THAs were performed using cementless components when looking at all causes for revision, even after adjusting for the most likely confounding factors. Our data suggest that increased use of cemen...