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Choice of Hospital for Revision Total Hip Replacement
Jeffrey N. Katz, MD, MSc1; Elizabeth A. Wright, PhD1; John Wright, MD1; Kelly L. Corbett, BS1; Henrik Malchau, MD2; John A. Baron, MD, MPH3; Elena Losina, PhD1
1 Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women's Hospital, BC-4th floor, 75 Francis Street, Boston, MA 02115. E-mail address for J.N. Katz: jnkatz@partners.org
2 Department of Orthopaedic Surgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114
3 Department of Medicine and of Family and Community Medicine, Dartmouth Medical School, One Medical Center Drive, Lebanon, NH 03756
View Disclosures and Other Information
Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants in excess of $10,000 from the National Institutes of Health (NIH P60 AR 47782, NIH K24 02123, NIH K24 AR057827). Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity.

A commentary by Thomas J. Blumenfeld, MD, is available at www.jbjs.org/commentary and is linked to the online version of this article.
Investigation performed at Brigham and Women's Hospital, Boston, Massachusetts

Copyright © 2010 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2010 Dec 01;92(17):2829-2834. doi: 10.2106/JBJS.J.00182
A commentary by Thomas J. Blumenfeld, MD, is available here
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This article was updated on February 8, 2011, because of a previous error. In the first paragraph of the Results section (page 2831), the passage that had previously read "1339 (30%) were less than seventy-five years old" now reads "1539 (35%) were less than seventy-five years old".


Little is known about how often patients have revision total hip replacement in the same hospital in which they had the primary procedure.


We examined Medicare claims data to identify patients who had primary total hip replacement from July 1995 to June 1996 and subsequently had revision through December 31, 2006. We examined whether the revision was performed in the same or different hospital from the primary procedure, with different hospitals being categorized as being in a lower, a higher, or the same hospital volume stratum. Hospital strata included twenty-five or fewer cases of total hip replacement annually in the Medicare population, twenty-six to fifty cases, fifty-one to 100 cases, and >100 cases. We calculated the number of revisions generated (primary procedures eventuating in revision) by hospitals in each volume stratum and the number of revisions performed in these hospitals.


Of 4448 revision procedures, 3306 (74%) were performed in hospitals in the same volume stratum as the hospital where the primary procedure was performed. Four hundred twenty-nine revisions (9.6%) were performed in a lower-volume hospital, and 713 (16%) were performed in a higher-volume hospital. Thirty-one (3%) of 960 patients who had revision within one year after the primary total hip replacement had the revision in a lower-volume center, compared with 204 (15%) of 1393 who had revision more than six years after the primary procedure (odds ratio = 4.6 ; 95% confidence interval, 3.0 to 6.8). The ratio of revisions performed to revisions generated was 1.21 for the highest-volume centers and 0.86 for the lowest-volume centers.


Of 4448 revisions examined in this study, 429 (<10%) were performed in centers with a lower volume of total hip replacement than the center at which the initial hip replacement was performed, whereas 713 (16%) were performed in higher-volume centers. Higher-volume centers performed 21% more revisions than they generated (531 revisions performed, compared with 438 generated). These data will help to inform health-care policy with regard to the utilization of resources for revision total hip replacement.

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