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Related Experiment Videos

Survival following total hip replacement.

Jane Barrett1, Elena Losina, John A Baron

  • 1Department of Medicine, Section of Biostatistics and Epidemiology, Dartmouth Medical School, Evergreen Building, Suite 300, 46 Centerra Parkway, Lebanon, NH 03766, USA. jane.a.barrett@dartmouth.edu

The Journal of Bone and Joint Surgery. American Volume
|September 6, 2005
PubMed
Summary

Total hip replacement recipients show improved long-term survival compared to matched controls. While some benefit may stem from patient selection, the procedure itself may offer a protective effect against mortality.

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Area of Science:

  • Orthopedic Surgery
  • Geriatric Medicine
  • Public Health

Background:

  • Studies indicate total hip replacement (THR) patients live longer than controls, but the reason is unclear.
  • This investigation aimed to determine if THR's survival benefit is causal or due to confounding factors like comorbidity.

Purpose of the Study:

  • To assess the causal nature of the association between total hip replacement and increased longevity.
  • To differentiate the effect of patient selection from the potential protective impact of the procedure itself.

Main Methods:

  • A cohort of 28,469 Medicare enrollees undergoing elective primary THR in 1996 was compared to a matched control group.
  • Comorbidity was assessed using Medicare hospital claims for sixteen serious discharge diagnoses in the year prior to surgery.

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  • Survival patterns were analyzed using proportional hazards regression over three follow-up periods: 0-90 days, 90 days to 5 years, and >5 years post-procedure.

    • Main Results:

    • The THR cohort exhibited approximately 30% lower comorbidity than controls.
    • Despite adjusting for predictors like age, sex, and comorbidity, THR patients demonstrated better long-term survival.
    • While immediate post-operative mortality was higher in the THR group, it significantly decreased by three months, becoming lower than controls.

    Conclusions:

    • Total hip replacement recipients in the Medicare population experience longer survival than matched controls.
    • The rapid emergence of lower mortality suggests patient selection (low-risk individuals) contributes significantly.
    • However, the protective effect persisted even after adjusting for comorbidity, indicating the procedure itself may have a beneficial impact.