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 Adult Hip Reconstruction Test 1: Primary Total Hip Arthroplasty
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The Journal of Bone and Joint Surgery (American) 85:27-32 (2003)
© 2003 The Journal of Bone and Joint Surgery, Inc.

Scientific Article

Rates and Outcomes of Primary and Revision Total Hip Replacement in the United States Medicare Population

Nizar N. Mahomed, MD, ScD, FRCSC, Jane A. Barrett, MSc, Jeffrey N. Katz, MD, MS, Charlotte B. Phillips, RN,MPH, Elena Losina, PhD, Robert A. Lew, PhD, Edward Guadagnoli, PhD, William H. Harris, MD, Robert Poss, MD and John A. Baron, MD,MPH


Nizar N. Mahomed, MD, ScD, FRCSC
Toronto Western Hospital, 399 Bathurst Street, ECW 1-002, Toronto, ON M5T 2S8, Canada. E-mail address: nizar.mahomed{at}utoronto.ca

Jane A. Barrett, MSc
John A. Baron, MD, MPH
Department of Community and Family Medicine, Dartmouth Medical School, Hanover, NH 03755

Jeffrey N. Katz, MD, MS
Charlotte B. Phillips, RN, MPH
Robert A. Lew, PhD
Robert Poss, MD
Robert Breck Brigham Multipurpose Arthritis and Musculoskeletal Diseases Center (J.N.K., C.B.P., and R.A.L.), Division of Rheumatology, Immunology and Allergy (J.N.K. and R.A.L.), and Department of Orthopaedic Surgery (R.P.), Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115

Elena Losina, PhD
Department of Epidemiology and Biostatistics, Boston University School of Public Health, 715 Albany Street, Boston, MA 02118

Edward Guadagnoli, PhD
Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115

William H. Harris, MD
Department of Orthopaedics, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114

In support of their research or preparation of this manuscript, one or more of the authors received grants or outside funding from the National Institutes of Health (Grants PO1 AR36308 and K24 AR02123), the Agency for Healthcare Research and Quality (Grant 1R01 HS09775-01), The Arthritis Foundation, The American Academy of Orthopaedic Surgeons, The Orthopaedic Research and Education Foundation, and the Canadian Arthritis Society. None of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Background: Information on the epidemiology of primary total hip replacement is limited, and we are not aware of any reports on the epidemiology of revision total hip replacement. The objective of this study was to characterize the rates and immediate postoperative outcomes of primary and revision total hip replacement in persons sixty-five years of age and older residing in the United States.

Methods: We used Medicare claims submitted by hospitals, physicians, and outpatient facilities between July 1, 1995, and June 30, 1996, to identify individuals who had undergone elective primary total hip replacement for a reason other than a fracture (61,568 patients) or had had revision total hip replacement (13,483 patients). Annual incidence rates of primary and revision total hip replacement were calculated, and multivariate modeling was used to evaluate the association between patient characteristics and surgical rates. The rates of occurrence of five complications within ninety days postoperatively were also evaluated, and relationships between those outcomes and patient characteristics were assessed with use of multivariate models adjusted for hospital and surgeon volume.

Results: The rates of primary total hip replacement were three to six times higher than the rates of revision total hip replacement. Women had higher rates than men, and whites had higher rates than blacks. The rates of primary and revision total hip replacement increased with age until the age of seventy-five to seventy-nine years and then declined. The rates of complications occurring within ninety days after primary total hip replacement were 1.0% for mortality, 0.9% for pulmonary embolus, 0.2% for wound infection, 4.6% for hospital readmission, and 3.1% for hip dislocation. The rates after revision total hip replacement were 2.6%, 0.8%, 0.95%, 10.0%, and 8.4%, respectively. Factors associated with an increased risk of an adverse outcome included increased age, gender (men were at higher risk than women), race (blacks were at higher risk than whites), a medical comorbidity, and a low income.

Conclusions: Analysis of United States Medicare population data showed that the rates of total hip replacement increased with age up to the age of seventy-five to seventy-nine years and that blacks had a significantly lower rate of total hip replacement than whites. The overall rates of adverse outcomes were relatively low, but they were significantly higher after revision than after primary total hip replacement.

Level of Evidence: Prognostic study, Level II-1 (retrospective study). See p. 2 for complete description of levels of evidence.


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