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Burden and characteristics of revision total hip arthroplasty in China: a national study based on hospitalised cases
Haoran Feng1,2,3, Yuqing Wang2,3,4, Dongxing Xie1,2,3
1Orthopaedics, Xiangya Hospital Central South University, Changsha, Hunan, China.
Insights
The burden of revision total hip arthroplasty (THA) in China is increasing, with prosthesis loosening as the primary cause. Significant regional disparities and patient migration patterns were observed.
Area of Science:
- Orthopedic surgery
- Public health
- Epidemiology
Background:
- Revision total hip arthroplasty (THA) is a growing concern globally.
- Understanding the trends and characteristics of revision THA is crucial for healthcare planning.
Purpose of the Study:
- To investigate the burden and characteristics of revision THA in China.
- To analyze trends in revision burden, indications, costs, and patient migration patterns.
Main Methods:
- National retrospective study using the Hospital Quality Monitoring System (HQMS) from 2013-2018.
- Included 13,029 revision THA cases.
- Analyzed revision burden, indications, hospital charges, and patient migration.
Main Results:
- Revision THA burden increased from 4.5% to 5.4% between 2013 and 2018.
- Prosthesis loosening (44.0%) was the leading indication.
- Hospitalization charges initially increased then decreased; significant patient migration to major cities like Shanghai and Beijing was observed.
Conclusions:
- Revision THA burden in China is rising, with distinct etiological characteristics.
- Significant regional disparities exist, driving patient migration for treatment.
- Epidemiological data from national databases are vital for understanding and managing revision THA.
Objective:
This study aimed to investigate the burden and characteristics of revision total hip arthroplasty (THA) in China.
Design:
A national retrospective study was conducted based on the Hospital Quality Monitoring System (HQMS) in China. Patients who underwent revision total hip arthroplasty (THA) between 2013 and 2018 were included. Revision burden was calculated as the ratio of revision procedures to the total number of THA procedures. Demographic and hospital characteristics, hospitalisation charges, clinical indications and patient migration patterns related to revision THA were analysed.
Setting:
Tertiary hospitals across China.
Participants:
A total of 13 029 revision THA cases from HQMS.
Primary Outcome Measures:
Revision burden, indications for revision, hospitalisation charges, hospital level, patient migration and their trend.
Results:
During the study period, 13 029 revision THA cases were identified. The revision burden showed an increasing trend from 2013 to 2018 (4.5% to 5.4%; p for trend=0.002). The hospitalisation charges continued to increase between 2013 and 2016 and decreased over the next 2 years. The leading indications for revision THA were prosthesis loosening (44.0%), prosthesis dysfunction (13.7%) and fracture (10.7%). More than 60% of patients were hospitalised in provincial hospitals, but this proportion gradually decreased over time. 14.8% of patients were hospitalised in a hospital outside the province of their residence. Shanghai and Beijing were the most preferred migration destinations, with 63.5% and 52.0% of patients from outside provinces, respectively.
Conclusions:
This study provided epidemiological data on revision THA in China based on a national database. During the study period, there was an increasing trend in the revision burden, and hospitalisation costs shifted from an annual increase to a decrease. China exhibits distinct characteristics regarding indications for revision THA. Additionally, significant regional disparities in revision THA were evident, leading to a considerable phenomenon of migration.
