Instability Is the Most Common Indication for Revision Hip Arthroplasty in the United States: National Trends From 2012 to 2018

Background: As primary total hip arthroplasty volume continues to increase, so will the number of revision total hip arthroplasty (rTHA) procedures. These complex cases represent a significant clinical and financial burden to the health-care system. Methods: This was a retrospective review using the...

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Autores principales:	Alex Upfill-Brown, MD, MSc, Peter P. Hsiue, MD, Troy Sekimura, BS, Jay N. Patel, DO, Micah Adamson, MD, Alexandra I. Stavrakis, MD
Formato:	article
Lenguaje:	EN
Publicado:	Elsevier 2021
Materias:	Revision hip arthroplasty Aseptic loosening Prosthetic joint infection Periprosthetic instability Healthcare utilization Orthopedic surgery RD701-811
Acceso en línea:	https://doaj.org/article/a80154cb1aca4a6db7351e778af58576
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spelling	oai:doaj.org-article:a80154cb1aca4a6db7351e778af585762021-11-14T04:33:54ZInstability Is the Most Common Indication for Revision Hip Arthroplasty in the United States: National Trends From 2012 to 20182352-344110.1016/j.artd.2021.08.001https://doaj.org/article/a80154cb1aca4a6db7351e778af585762021-10-01T00:00:00Zhttp://www.sciencedirect.com/science/article/pii/S2352344121001357https://doaj.org/toc/2352-3441Background: As primary total hip arthroplasty volume continues to increase, so will the number of revision total hip arthroplasty (rTHA) procedures. These complex cases represent a significant clinical and financial burden to the health-care system. Methods: This was a retrospective review using the National Inpatient Sample. International Classification of Diseases, 9th and 10th revision codes were used to identify patients who underwent rTHA and create cohorts based on rTHA indications from 2012 to 2018. National and regional trends for length of stay (LOS), cost, and discharge location were evaluated. Results: A total of 292,250 rTHA procedures were identified. The annual number of rTHA procedures increased by 28.1% from 2012 to 2018 (37,325 to 47,810). The top 3 indications for rTHA were instability (20.4%), aseptic loosening (17.8%), and infection (11.1%). Over the study period, the proportion of patients discharged to skilled nursing facility decreased from 44.2% to 38% (P < .001). Hospital LOS decreased on average from 4.8 to 4.4 days (P < .001). Infections had the highest average LOS (7.3 days) followed by periprosthetic fractures (6.5 days). Hospital costs decreased over the study period, from $25,794 to $24,555 (P < .001). The proportion of rTHA cases performed at urban academic centers increased (58.0% to 75.3%, P < .001) while the proportion performed at urban nonacademic centers decreased (35.5% to 19.4%, P < .001). Conclusion: Instability was the most common indication for rTHA between 2012 and 2018. The proportion of rTHA performed in urban academic centers has increased substantially, away from urban nonacademic centers. While cost and LOS have decreased, significant geographic variability exists.Alex Upfill-Brown, MD, MScPeter P. Hsiue, MDTroy Sekimura, BSJay N. Patel, DOMicah Adamson, MDAlexandra I. Stavrakis, MDElsevierarticleRevision hip arthroplastyAseptic looseningProsthetic joint infectionPeriprosthetic instabilityHealthcare utilizationOrthopedic surgeryRD701-811ENArthroplasty Today, Vol 11, Iss , Pp 88-101 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Revision hip arthroplasty Aseptic loosening Prosthetic joint infection Periprosthetic instability Healthcare utilization Orthopedic surgery RD701-811
spellingShingle	Revision hip arthroplasty Aseptic loosening Prosthetic joint infection Periprosthetic instability Healthcare utilization Orthopedic surgery RD701-811 Alex Upfill-Brown, MD, MSc Peter P. Hsiue, MD Troy Sekimura, BS Jay N. Patel, DO Micah Adamson, MD Alexandra I. Stavrakis, MD Instability Is the Most Common Indication for Revision Hip Arthroplasty in the United States: National Trends From 2012 to 2018
description	Background: As primary total hip arthroplasty volume continues to increase, so will the number of revision total hip arthroplasty (rTHA) procedures. These complex cases represent a significant clinical and financial burden to the health-care system. Methods: This was a retrospective review using the National Inpatient Sample. International Classification of Diseases, 9th and 10th revision codes were used to identify patients who underwent rTHA and create cohorts based on rTHA indications from 2012 to 2018. National and regional trends for length of stay (LOS), cost, and discharge location were evaluated. Results: A total of 292,250 rTHA procedures were identified. The annual number of rTHA procedures increased by 28.1% from 2012 to 2018 (37,325 to 47,810). The top 3 indications for rTHA were instability (20.4%), aseptic loosening (17.8%), and infection (11.1%). Over the study period, the proportion of patients discharged to skilled nursing facility decreased from 44.2% to 38% (P < .001). Hospital LOS decreased on average from 4.8 to 4.4 days (P < .001). Infections had the highest average LOS (7.3 days) followed by periprosthetic fractures (6.5 days). Hospital costs decreased over the study period, from $25,794 to $24,555 (P < .001). The proportion of rTHA cases performed at urban academic centers increased (58.0% to 75.3%, P < .001) while the proportion performed at urban nonacademic centers decreased (35.5% to 19.4%, P < .001). Conclusion: Instability was the most common indication for rTHA between 2012 and 2018. The proportion of rTHA performed in urban academic centers has increased substantially, away from urban nonacademic centers. While cost and LOS have decreased, significant geographic variability exists.
format	article
author	Alex Upfill-Brown, MD, MSc Peter P. Hsiue, MD Troy Sekimura, BS Jay N. Patel, DO Micah Adamson, MD Alexandra I. Stavrakis, MD
author_facet	Alex Upfill-Brown, MD, MSc Peter P. Hsiue, MD Troy Sekimura, BS Jay N. Patel, DO Micah Adamson, MD Alexandra I. Stavrakis, MD
author_sort	Alex Upfill-Brown, MD, MSc
title	Instability Is the Most Common Indication for Revision Hip Arthroplasty in the United States: National Trends From 2012 to 2018
title_short	Instability Is the Most Common Indication for Revision Hip Arthroplasty in the United States: National Trends From 2012 to 2018
title_full	Instability Is the Most Common Indication for Revision Hip Arthroplasty in the United States: National Trends From 2012 to 2018
title_fullStr	Instability Is the Most Common Indication for Revision Hip Arthroplasty in the United States: National Trends From 2012 to 2018
title_full_unstemmed	Instability Is the Most Common Indication for Revision Hip Arthroplasty in the United States: National Trends From 2012 to 2018
title_sort	instability is the most common indication for revision hip arthroplasty in the united states: national trends from 2012 to 2018
publisher	Elsevier
publishDate	2021
url	https://doaj.org/article/a80154cb1aca4a6db7351e778af58576
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Instability Is the Most Common Indication for Revision Hip Arthroplasty in the United States: National Trends From 2012 to 2018

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