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Treatment of Femoral Head Osteonecrosis in the United States: 16-year Analysis of the Nationwide Inpatient Sample

  • Symposium: 2013 Hip Society Proceedings
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Many surgical interventions are used to treat osteonecrosis of the femoral head. The instance and distribution of these various procedures may give some insight into the practicing community’s understanding of the efficacy of these treatments. We therefore sought to determine trends in the types and numbers of procedures performed for atraumatic osteonecrosis from 1992 through 2008 in the United States.

Questions/purposes

(1) How has the overall incidence of surgical treatment for atraumatic osteonecrosis changed over this time period; and (2) how has the percentage of THA performed for osteonecrosis (compared with joint-preserving procedures) changed over this time period?

Methods

The Nationwide Inpatient Sample database was used to collect information for all patients who had an International Classification of Diseases, 9th Revision diagnosis of hip osteonecrosis between 1992 and 2008. Procedures were collated according to frequency, and trends were analyzed for joint-preserving and joint-replacing procedures.

Results

The total number of procedures performed over this time period for osteonecrosis of the hip increased from 3570 procedures to 6400 procedures per year. In 1992, 75% (n = 2678) of the procedures performed to treat osteonecrosis of the hip were THA, which increased to 88% (n = 5632) in 2008. The percentage of joint-preserving procedures consequently decreased from 25% to 12% over this period.

Conclusions

Previously, THA was believed to have poor survivorship and clinical results for the treatment of osteonecrosis of the hip, but reports since 1993 have suggested improved survivorship of these reconstructions. Our study suggests that surgeons have incorporated this into their practice patterns, in that an increasing percentage of patients with this diagnosis are treated with THA. Additionally, the total number of procedures performed for osteonecrosis has increased, which may reflect an improved awareness of this disease and more aggressive approaches to diagnosis and treatment.

Level of Evidence

Level III, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.

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Authors and Affiliations

  1. Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD, USA

    Aaron J. Johnson MD & Michael A. Mont MD

  2. Sun Valley Orthopaedic Surgeons, Surprise, AZ, USA

    Audrey K. Tsao MD

  3. Johns Hopkins Orthopaedics at Good Samaritan Hospital, The Johns Hopkins University School of Medicine, 5601 Loch Raven Boulevard, Baltimore, MD, 21239, USA

    Lynne C. Jones PhD

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  1. Aaron J. Johnson MD
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  2. Michael A. Mont MD
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  3. Audrey K. Tsao MD
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  4. Lynne C. Jones PhD
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Correspondence to Lynne C. Jones PhD.

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Johnson, A.J., Mont, M.A., Tsao, A.K. et al. Treatment of Femoral Head Osteonecrosis in the United States: 16-year Analysis of the Nationwide Inpatient Sample. Clin Orthop Relat Res 472, 617–623 (2014). https://doi.org/10.1007/s11999-013-3220-3

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