Abstract
Background
Patient, surgeon, health system, and device factors are all known to influence outcomes in THA. However, patient-related factors associated with an increased risk of early failure are poorly understood, particularly in elderly patients.
Questions/purposes
We identified specific demographic and clinical characteristics associated with increased risk of early revision in Medicare patients with THA.
Methods
The Medicare 5% national sample administrative database was used to calculate the relative risk of revision within 12 months following primary THA as a function of baseline medical comorbidities in 56,030 Medicare patients who underwent primary THA between 1998 and 2010. The impact of 29 comorbid conditions on risk of early revision was examined using Cox regression, controlling for age, sex, race, US Census region, socioeconomic status, and all other baseline comorbidities.
Results
Depression, rheumatologic disease, psychoses, renal disease, chronic urinary tract infection, and congestive heart failure were associated with revision THA within 12 months of the index arthroplasty (p ≤ 0.038 for all comparisons; risk factors listed in order of significance).
Conclusions
This information is important when counseling elderly patients with THA regarding the risk of early failure and for risk stratifying publicly reported outcomes in Medicare patients with THA.
Level of Evidence
Level II, prognostic study. See Instructions for Authors for a complete description of levels of evidence.
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One of the authors (EL) certifies that he, or a member of his immediate family, has received or may receive payments or benefits, during the study period, an amount of USD 100,001 to USD 1,000,000, from Exponent, Inc (Menlo Park, CA, USA). One of the authors (SMK) certifies that he, or a member of his immediate family, has received or may receive payments or benefits, during the study period, an amount of USD 100,001 to USD 1,000,000, from Exponent, Inc (Philadelphia, PA, USA). One of the authors (TPV) certifies that he, or a member of his immediate family, has received or may receive payments or benefits, during the study period, an amount of USD 10,000 to USD 100,000, from DePuy Orthopaedics, Inc (Warsaw, IN, USA). One of the authors (DJB) certifies that he, or a member of his immediate family, has received or may receive payments or benefits, during the study period, an amount of USD 100,001 to USD 1,000,000, from DePuy Orthopaedics, Inc.
All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.
Each author certifies that the institution where the work was performed approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.
This work was performed at University of California, San Francisco (San Francisco, CA, USA) and Exponent, Inc (Menlo Park, CA, USA, and Philadelphia, PA, USA).
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Bozic, K.J., Lau, E., Ong, K. et al. Risk Factors for Early Revision After Primary Total Hip Arthroplasty in Medicare Patients. Clin Orthop Relat Res 472, 449–454 (2014). https://doi.org/10.1007/s11999-013-3081-9
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DOI: https://doi.org/10.1007/s11999-013-3081-9