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Current Trends in Revision Hip Arthroplasty: Indications and Types of Components Revised
Zoe W Hinton1, Christine J Wu1, Sean P Ryan1
1Department of Orthopaedic Surgery, Duke University, Durham, North Carolina.
Insights
Indications for revision total hip arthroplasty (THA) shifted, with fewer dislocations and more loosening. Component and femoral revisions rose, while acetabular and head/liner exchanges declined, impacting costs and stay length.
Area of Science:
- Orthopedic Surgery
- Arthroplasty Research
- Health Economics
Background:
- Total hip arthroplasty (THA) materials and techniques have evolved.
- Understanding changes in revision THA indications and outcomes is crucial.
Purpose of the Study:
- To evaluate temporal trends in revision total hip arthroplasty (THA) indications.
- To analyze changes in component utilization, length of stay (LOS), and associated payments.
- To identify shifts in the types of revision procedures performed.
Main Methods:
- Retrospective analysis of 38,377 revision THA cases from 2010-2018 using the PearlDiver database.
- Logistic regression for indications and component analysis; linear regression for revision totals.
- Analysis of variance (ANOVA) for length of stay (LOS) and payment data.
Main Results:
- Revisions for dislocation decreased (OR 0.82), while those for loosening increased (OR 1.54).
- Both-component (OR 1.45) and femoral component revisions increased; acetabular (OR 0.57) and head/liner exchanges decreased.
- Average LOS decreased (-0.68 days), surgeon payments decreased (-$261.8), but facility payments increased ($4,211).
Conclusions:
- Revision THA indications have shifted towards increased loosening and decreased dislocation.
- Trends show an increase in both-component and femoral revisions, with a decrease in acetabular and head/liner exchanges.
- Further research is needed to explore factors influencing these trends, such as fixation methods and surgical approaches.
Background:
The materials and techniques for both primary and revision total hip arthroplasty (THA) have changed over time. This study evaluated if the indications for revision THA, rates of components utilized (femoral or acetabulum, both, or head/liner exchange), length of stay (LOS), and payments to surgeons and facilities have also changed.
Methods:
A retrospective study, utilizing the PearlDiver database, of 38,377 revision THA patients from January 2010 through December 2018 was performed. Data included the indication for revision, components revised (femoral or acetabulum, both, or head/liner exchange), LOS, and payments. Indications and components were analyzed by logistic regression (Dunnett's post hoc test). Revision totals were analyzed with a linear regression model. Analysis of variance assessed changes in LOS and payments.
Results:
Patients' median age was 67 years (Q1-Q3: 59-74), and 58.7% were female. Revisions for dislocation decreased between 2010 and 2018 (odds ratio [OR] 0.82, 95% confidence interval [CI] 0.68-0.98). Revisions for component loosening increased (OR 1.54, 95% CI 1.25-1.91). Dislocation remained the most common indication (19.3%), followed by PJI (17.3%) and loosening (17.1%). Both-component (OR:1.45; 95% CI:1.25-1.67) and femoral component only revisions increased; acetabular component only and head/liner exchanges decreased. Acetabular (OR 0.57, 95% CI 0.47-0.70) and head/liner exchange (OR 0.29, 95% CI 0.20-0.43) revisions decreased, while both component exchange (OR 1.45, 95% CI 1.25-1.67) and femoral revisions (OR 1.17, 95% CI 0.99-1.37) increased. Average LOS (-0.68 days; P < .001) and surgeon payments decreased (-$261.8; P < .001) while facility payments increased ($4,211; P < .001).
Conclusion:
Indications for revision THA in this database study changed over time, with revision for dislocation decreasing and revision for loosening increasing over time. Both component and femoral revisions increased, and acetabular component and head/liner exchanges decreased. It is possible that these associations could be attributed to a number of details, the method of femoral fixation, surgical approach, and cementing, all of which require additional study.
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