Revision Hip Arthroplasty:<i>A Retrospective Survey</i>

Broughton, Nigel S.; Rushton, Neil

doi:10.3109/17453678208992850

Cited by 14 publications

(2 citation statements)

References 6 publications

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“…Revisional arthroplasty has been reported t o be associated with an increased incidence of complications, and some authors recommend excisionid Girdlestone arthroplasty for failed THR (Hunter et al 1979). Whereas others have reported this outcome in one fifth of their cases (Broughton andRushton 1982, Dandy andTheodorou 1975). we had no Girdlestone arthroplasty in our series.…”

Section: Discussionmentioning

confidence: 91%

“…Surprisingly, the results after revision arthroplasty were only slightly inferior compared with primary arthroplasty, with satisfactory pain relief in 52 of the 60 patients. Wallensten and Olsson (1982) reported 64 per cent satisfactory results after revision arthroplasty, Broughton andRushton (1982) 58 per cent, whereas Hunter et al (1979) reported only 24 per cent. In these series the exchanged prostheses were cemented, which may explain (Jones 1979) the inferior outcome compared with the exchanged uncemented prostheses in our series.…”

Section: Discussionmentioning

confidence: 99%

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Revision of the uncemented hip prosthesis

Søballé

Olsen

Ejsted

et al. 1987

Acta Orthopaedica Scandinavica

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In a series of 213 consecutive total hip replacements a.m. Lubinus, the clinical course after 72 revisions and 141 primary procedures was compared after 5 years. The revised THRs were uncemented Ring prostheses. Dislocation and peroperative fracture were more common in the revision group. Two failures because of aseptic loosening occurred in the revision group and 3 in the control group. No excisional arthroplasty was required, and no infections occurred. Radiographic evaluation of prosthetic positioning, component loosening, calcar resorption, and paraarticular ossification disclosed only slightly inferior results in the revision group. Clinically, the revised cases were not inferior to the primary ones. Revision of the uncemented hip seems less difficult than of the cemented hip.

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Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Revision of the uncemented hip prosthesis

Søballé

Olsen

Ejsted

et al. 1987

Acta Orthopaedica Scandinavica

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A Cost-effectiveness Analysis of Total Hip Arthroplasty for Osteoarthritis of the Hip

Chang

Pellissier²,

Hazen

1996

JAMA

442

135

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Objective.\p=m-\Toquantify the trade-off between the expected increased shortand long-term costs and the expected increase in quality-adjusted life expectancy (QALE) associated with total hip arthroplasty (THA) for persons with functionally significant hip osteoarthritis.Design.\p=m-\Acost-effectiveness study was performed from the societal perspective by constructing stochastic tree, decision analytic models designed to estimate lifetime functional outcomes and costs of THA and nonoperative managements.Main Outcome Measures.\p=m-\Amodified four-state American College of Rheumatology functional status classification was used to measure effectiveness. These functional classes were assigned utility values to allow the relative effectiveness of THA to be expressed in quality-adjusted life years (QALYs). Lifetime costs included costs associated with primary and potential revision surgeries and long-term care costs associated with the functionally dependent class.Data Used in the Cost-effectiveness Model.\p=m-\Probability and incidence rate data were summarized from the literature. The THA hospital cost data were obtained from local teaching hospitals' cost accounting systems. Estimates of recurring medical costs for functionally significant hip osteoarthritis and for custodial care were derived from the literature.Results.\p=m-\TheTHA cost-effectiveness ratio increases with age and is higher for men than for women. In the base-case scenario for 60-year-old white women who have functionally significant but not dependent hip osteoarthritis, the model predicts that THA is cost saving because of the high costs of custodial care associated with dependency due to worsening hip osteoarthritis and that the procedure increases QALE by about 6.9 years. In the base-case scenario for men aged 85 years and older, the average lifetime cost associated with THA is $9100 more than nonoperative management, with an average increase in QALE of about 2 years. Thus, the THA cost-effectiveness ratio for men aged 85 years and older is $4600 per QALY gained, less than that of procedures intended to extend life such as coronary artery bypass surgery or renal dialysis. Worst-case analysis suggests that THA remains minimally cost-effective for this oldest age category ($80 000/QALY) even if probabilities, rates, utilities, costs, and the discount rate are simultaneously varied to extreme values that bias the analysis against surgery.Conclusions.\p=m-\For persons with hip osteoarthritis associated with significant functional limitation, THA can be cost saving or, at worst, cost-effective in improving QALE when both short-and long-term outcomes are considered. Further research is needed to determine whether this procedure is actually being used in this cost-effective manner, especially in older age categories.

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