The Journal of Bone and Joint Surgery (American). 2009;91:128-133.
doi:10.2106/JBJS.H.00155
© 2009 The Journal of Bone and Joint Surgery, Inc.
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The Epidemiology of Revision Total Hip Arthroplasty in the United States

Kevin J. Bozic, MD, MBA1, Steven M. Kurtz, PhD2, Edmund Lau, MS3, Kevin Ong, PhD2, Thomas P. Vail, MD1 and Daniel J. Berry, MD4

1 Department of Orthopaedic Surgery and Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, 500 Parnassus Avenue, MU 320W, San Francisco, CA 94143-0278. E-mail address for K.J. Bozic: bozick{at}orthosurg.ucsf.edu
2 Exponent, Inc., 3401 Market Street, Suite 300, Philadelphia, PA 19104
3 Exponent, Inc., 149 Commonwealth Drive, Menlo Park, CA 94025
4 Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN 55905

Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, and Philip R. Lee Institute for Health Policy Studies, San Francisco, California

Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants in excess of $10,000 from the Orthopaedic Research and Education Fund. In addition, one or more of the authors or a member of his or her immediate family received, in any one year, payments or other benefits in excess of $10,000 or a commitment or agreement to provide such benefits from commercial entities (DePuy, United Health Care). Also, commercial entities (DePuy, Zimmer, Stryker) paid or directed in any one year, or agreed to pay or direct, benefits in excess of $10,000 to a research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which one or more of the authors, or a member of his or her immediate family, is affiliated or associated.

Background: Understanding the causes of failure and the types of revision total hip arthroplasty performed is essential for guiding research, implant design, clinical decision-making, and health-care policy. The purpose of the present study was to evaluate the mechanisms of failure and the types of revision total hip arthroplasty procedures performed in the United States with use of newly implemented ICD-9-CM (International Classification of Diseases, Ninth Revision, Clinical Modification) diagnosis and procedure codes related specifically to revision total hip arthroplasty in a large, nationally representative population.

Methods: The Healthcare Cost and Utilization Project Nationwide Inpatient Sample database was used to analyze clinical, demographic, and economic data from 51,345 revision total hip arthroplasty procedures performed between October 1, 2005, and December 31, 2006. The prevalence of revision procedures was calculated for population subgroups in the United States that were stratified according to age, sex, diagnosis, census region, primary payer class, and type of hospital. The cause of failure, the average length of stay, and total charges were also determined for each type of revision arthroplasty procedure.

Results: The most common type of revision total hip arthroplasty procedure performed was all-component revision (41.1%), and the most common causes of revision were instability/dislocation (22.5%), mechanical loosening (19.7%), and infection (14.8%). Revision total hip arthroplasty procedures were most commonly performed in large, urban, nonteaching hospitals for Medicare patients seventy-five to eighty-four years of age. The average length of hospital stay for all types of revision arthroplasties was 6.2 days, and the average total charges were $54,553. However, the average length of stay, average charges, and procedure frequencies varied considerably according to census region, hospital type, and type of revision total hip arthroplasty procedure performed.

Conclusions: Hip instability and mechanical loosening are the most common indications for revision total hip arthroplasty in the United States. As further experience is gained with the new diagnosis and procedure codes specifically related to revision total hip arthroplasty, this information will be valuable in directing future research, implant design, and clinical decision-making.

Level of Evidence: Prognostic Level II. See Instructions to Authors for a complete description of levels of evidence.


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