0
Scientific Article   |    
Rates and Outcomes of Primary and Revision Total Hip Replacement in the United States Medicare Population
Nizar N. Mahomed, MD, ScD, FRCSC; Jane A. Barrett, MSc; Jeffrey N. Katz, MD, MS; Charlotte B. Phillips, RN,MPH; Elena Losina, PhD; Robert A. Lew, PhD; Edward Guadagnoli, PhD; William H. Harris, MD; Robert Poss, MD; John A. Baron, MD,MPH
View Disclosures and Other Information

Nizar N. Mahomed, MD, ScD, FRCSC
Toronto Western Hospital, 399 Bathurst Street, ECW 1-002, Toronto, ON M5T 2S8, Canada. E-mail address: nizar.mahomed@utoronto.ca

Jane A. Barrett, MSc
John A. Baron, MD, MPH
Department of Community and Family Medicine, Dartmouth Medical School, Hanover, NH 03755

Jeffrey N. Katz, MD, MS
Charlotte B. Phillips, RN, MPH
Robert A. Lew, PhD
Robert Poss, MD
Robert Breck Brigham Multipurpose Arthritis and Musculoskeletal Diseases Center (J.N.K., C.B.P., and R.A.L.), Division of Rheumatology, Immunology and Allergy (J.N.K. and R.A.L.), and Department of Orthopaedic Surgery (R.P.), Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115

Elena Losina, PhD
Department of Epidemiology and Biostatistics, Boston University School of Public Health, 715 Albany Street, Boston, MA 02118

Edward Guadagnoli, PhD
Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115

William H. Harris, MD
Department of Orthopaedics, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114

In support of their research or preparation of this manuscript, one or more of the authors received grants or outside funding from the National Institutes of Health (Grants PO1 AR36308 and K24 AR02123), the Agency for Healthcare Research and Quality (Grant 1R01 HS09775-01), The Arthritis Foundation, The American Academy of Orthopaedic Surgeons, The Orthopaedic Research and Education Foundation, and the Canadian Arthritis Society. None of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

J Bone Joint Surg Am, 2003 Jan 01;85(1):27-32
5 Recommendations (Recommend) | 3 Comments | Saved by 3 Users Save Case

Abstract

Background: Information on the epidemiology of primary total hip replacement is limited, and we are not aware of any reports on the epidemiology of revision total hip replacement. The objective of this study was to characterize the rates and immediate postoperative outcomes of primary and revision total hip replacement in persons sixty-five years of age and older residing in the United States.

Methods: We used Medicare claims submitted by hospitals, physicians, and outpatient facilities between July 1, 1995, and June 30, 1996, to identify individuals who had undergone elective primary total hip replacement for a reason other than a fracture (61,568 patients) or had had revision total hip replacement (13,483 patients). Annual incidence rates of primary and revision total hip replacement were calculated, and multivariate modeling was used to evaluate the association between patient characteristics and surgical rates. The rates of occurrence of five complications within ninety days postoperatively were also evaluated, and relationships between those outcomes and patient characteristics were assessed with use of multivariate models adjusted for hospital and surgeon volume.

Results: The rates of primary total hip replacement were three to six times higher than the rates of revision total hip replacement. Women had higher rates than men, and whites had higher rates than blacks. The rates of primary and revision total hip replacement increased with age until the age of seventy-five to seventy-nine years and then declined. The rates of complications occurring within ninety days after primary total hip replacement were 1.0% for mortality, 0.9% for pulmonary embolus, 0.2% for wound infection, 4.6% for hospital readmission, and 3.1% for hip dislocation. The rates after revision total hip replacement were 2.6%, 0.8%, 0.95%, 10.0%, and 8.4%, respectively. Factors associated with an increased risk of an adverse outcome included increased age, gender (men were at higher risk than women), race (blacks were at higher risk than whites), a medical comorbidity, and a low income.

Conclusions: Analysis of United States Medicare population data showed that the rates of total hip replacement increased with age up to the age of seventy-five to seventy-nine years and that blacks had a significantly lower rate of total hip replacement than whites. The overall rates of adverse outcomes were relatively low, but they were significantly higher after revision than after primary total hip replacement.

Level of Evidence: Prognostic study, Level II-1 (retrospective study). See p. 2 for complete description of levels of evidence.

Figures in this Article
    Sign In to Your Personal ProfileSign In To Access Full Content
    Not a Subscriber?
    Get online access for 30 days for $35
    New to JBJS?
    Sign up for a full subscription to both the print and online editions
    Register for a FREE limited account to get full access to all CME activities, to comment on public articles, or to sign up for alerts.
    Register for a FREE limited account to get full access to all CME activities
    Have a subscription to the print edition?
    Current subscribers to The Journal of Bone & Joint Surgery in either the print or quarterly DVD formats receive free online access to JBJS.org.
    Forgot your password?
    Enter your username and email address. We'll send you a reminder to the email address on record.

     
    Forgot your username or need assistance? Please contact customer service at subs@jbjs.org. If your access is provided
    by your institution, please contact you librarian or administrator for username and password information. Institutional
    administrators, to reset your institution's master username or password, please contact subs@jbjs.org

    References

    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
    CME Activities Associated with This Article
    Submit a Comment
    Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
    Comments are moderated and will appear on the site at the discretion of JBJS editorial staff.

    * = Required Field
    (if multiple authors, separate names by comma)
    Example: John Doe





    Related Content
    The Journal of Bone & Joint Surgery
    JBJS Case Connector
    Topic Collections
    Hip
    Related Audio and Videos
    PubMed Articles
    Clinical Trials
    Readers of This Also Read...
    JBJS Jobs
    01/22/2014
    Pennsylvania - Penn State Milton S. Hershey Medical Center
    03/19/2014
    Massachusetts - The University of Massachusetts Medical School
    03/19/2014
    Virginia - VIRGINIA COMMONWEALTH UNIVERSITY MEDICAL CENTER