Revision total hip arthroplasty in the United States: national trends and in-hospital outcomes

Schwartz, Brian; Piponov, Hristo; Helder, Cory W.; Mayers, William F.; Gonzalez, Mark H.

doi:10.1007/s00264-016-3121-7

Cited by 48 publications

(48 citation statements)

References 31 publications

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“…We found that 40% of all HRAs performed in the United States were in the South region. In a recent study, Schwartz et al 33 noted that the number of THA revisions was significantly greater in the South region (32.4%); thus, it seems intuitive that this is the region with the highest number of salvage procedures after failed revision THAs as well. Both the Northeast and Midwest regions had a significant decrease in the overall number of HRAs performed annually, which is in concert with the overall decreased number of HRAs performed nationally.…”

Section: Discussionmentioning

confidence: 98%

Trends in Hip Resection Arthroplasty in the Medicare Patient Population from 2005 to 2012

et al. 2017

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Hip resection arthroplasty (HRA) is a relatively uncommon, yet viable surgical procedure originally developed by Girdlestone for osteomyelitis of the proximal femur. Currently, HRA is primarily indicated as a salvage procedure after a failed total hip arthroplasty. Despite a continuous rise in the rates of primary and revision hip arthroplasty, there is a lack of published evidence regarding the extent of HRA's current use and its recent trends. We sought to provide an epidemiological description of the recent utilization patterns of HRA in the United States. A level of evidence IV, retrospective case series review of the entire Medicare files between 2005 and 2012 was conducted through the use of current procedural terminology codes and International Classification of Disease ninth edition codes. Linear regressions and chi-square tests were used for analysis. Subgroup analysis was performed by patient age. The total number of HRAs performed between 2005 and 2012 significantly decreased from 4,248 to 3,872 (p = 0.025). There was a significant increase in the annual incidence of HRA among patients younger than 65 years (p = 0.027; 9% increase) and patients 65 to 69 years old (p = 0.007; 22% increase), constituting 43% of the total patients. There was a significant decrease in HRA incidence among patients 80 to 84 years old (p = 0.001; 32% decrease) and patients 85 years old and over (p = 0.002; 24% decrease). Geographic analysis demonstrated the most HRA procedures were performed in the South, whereas gender focused analysis demonstrated a statistically significant decrease in HRA incidence for females (p = 0.003; 6% decrease) and a significant increase in incidence for males (p = 0.003; 7% increase). The overall annual incidence of HRA performed in the Medicare patient population has significantly decreased in recent years. However, this conceals an increased incidence among the relatively younger patient population. Potential causes for these opposing trends include changes in rates of revision surgery, alternative indications for surgery, advances in hardware, and surgeon expertise. This was a level of evidence IV, retrospective case series study.

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Section: Discussionmentioning

confidence: 98%

Trends in Hip Resection Arthroplasty in the Medicare Patient Population from 2005 to 2012

et al. 2017

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“…In addition, isolated acetabular component revision was not a risk factor for blood transfusion in the 2005 to 2010 group, possibly owing to the fact that a greater number of acetabular revisions in that time frame were performed for osteolysis. 13,73,74 These complex pelvic reconstructions may place patients at increased risk of significant blood loss requiring transfusion, and due to their increased prevalence in earlier years, the protective effect of isolated acetabular component revision on transfusion requirements was not observed in the 2005 to 2010 cohort.…”

Section: Discussionmentioning

confidence: 99%

“…10,11 In addition, rTHA has previously been associated with lower quality of life, decreased functional outcomes, and an increased complication rate compared with primary THA. 12,13 Mechanical complications are among the most common reasons for performing rTHA, accounting for up to 42 to 50% of all rTHA indications. 14 Aseptic loosening, instability, implant wear, and osteolysis are all potential etiologies for mechanical failure in THA.…”

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confidence: 99%

Risk Factors for Blood Transfusion in Revision Total Hip Arthroplasty for Mechanical Failure

Lee

Fassihi

et al. 2020

The Journal of Hip Surgery

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Revision total hip arthroplasty (rTHA) is associated with significant intraoperative blood loss requiring transfusion. Given that blood transfusions increase the risk of numerous complications, efforts should be made to determine which patients are at high risk of transfusion and optimize them appropriately. This study aimed to identify independent risk factors associated with blood transfusion in patients undergoing rTHA for mechanical failure. A multi-institutional surgical registry was queried for all patients who underwent rTHA for mechanical failure from 2005 to 2016. Patients were divided into transfused and nontransfused cohorts and underwent univariate analysis for differences in demographic features, preoperative comorbidities, and operative variables. Multivariate regression models were generated to elucidate independent risk factors associated with perioperative blood transfusions. A total of 8,469 rTHA patients met inclusion and exclusion criteria, of which 1,863 (22.0%) received blood transfusions within 72 hours postoperatively. On multivariate logistic regression analysis, age ≥ 65 years (odds ratio [OR] 1.313; p < 0.001), female gender (OR 1.465; p < 0.001), insulin-dependent diabetes mellitus (OR 1.503; p = 0.003), chronic obstructive pulmonary disease (COPD; OR 1.307; p = 0.030), hypertension (OR 1.359; p < 0.001), hematologic disorders (OR 1.565; p < 0.001), preoperative blood transfusions (OR 3.851; p < 0.001), systemic sepsis (OR 2.277; p = 0.003), functional dependence (OR 1.416; p = 0.003), open wounds/wound infections (OR 2.878; p < 0.001), and operations lasting at least 175 minutes (OR 4.841; p < 0.001) were all significant independent risk factors for blood transfusions. Obesity (body mass index [BMI] ≥ 30 kg/m2; OR 0.818; p = 0.001), smoking history (OR 0.800; p = 0.014), and isolated acetabular component revision (OR 0.730; p < 0.001) were associated with a decreased risk of blood transfusion. Older age, female gender, lower BMI, absence of smoking history, functional dependence, insulin-dependent diabetes mellitus, hypertension, revision of the femoral component, preoperative transfusion, hematologic disorders, sepsis, open wounds/wound infections, COPD, and longer operative time were all independent risk factors for blood transfusions in rTHA performed for mechanical failure. By identifying these risk factors, clinicians can identify and optimize high-risk patients to minimize blood transfusion requirements, thereby reducing the risk of transfusion-associated complications in this patient population.

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“…Increasing numbers of total hip arthroplasties (THA) are performed each year globally [1,2]. This procedure is noted to be highly successful.…”

Section: Introductionmentioning

confidence: 99%

“…This procedure is noted to be highly successful. However, around 7-17% of THAs across the world between 2001 and 2016 required surgical revision for various reasons [1][2][3]. Dislocation of the hip joint is one of the most common reasons for operative revision within the first year [3,4].…”

Section: Introductionmentioning

confidence: 99%

Innervation of the hip joint capsular complex: A systematic review of histological and immunohistochemical studies and their clinical implications for contemporary treatment strategies in total hip arthroplasty

et al. 2020

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The hip joint capsule contributes to the stability of the hip joint and lower extremity, yet this structure is incised and often removed during total hip arthroplasty (THA). Increasing incidence of osteoarthritis is accompanied by a dramatic rise in THAs over the last few decades. Consequently, to improve this treatment, THA with capsular repair has evolved. This partial restoration of physiological hip stability has resulted in a substantial reduction in post-operative dislocation rates compared to conventional THA without capsular repair. A further reason for the success of this procedure is thought to be the preservation of the innervation of the capsule. A systematic review of studies investigating the innervation of the hip joint capsular complex and pseudocapsule with histological techniques was performed, as this is not well established. The literature was sought from databases Amed, Embase and Medline via OVID, PubMed, ScienceDirect, Scopus and Web of Science; excluding articles without a histological component and those involving animals. A total of 21 articles on the topic were identified. The literature indicates two primary outcomes and potential clinical implications of

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Revision total hip arthroplasty in the United States: national trends and in-hospital outcomes

Cited by 48 publications

References 31 publications

Trends in Hip Resection Arthroplasty in the Medicare Patient Population from 2005 to 2012

Trends in Hip Resection Arthroplasty in the Medicare Patient Population from 2005 to 2012

Risk Factors for Blood Transfusion in Revision Total Hip Arthroplasty for Mechanical Failure

Innervation of the hip joint capsular complex: A systematic review of histological and immunohistochemical studies and their clinical implications for contemporary treatment strategies in total hip arthroplasty

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