Gwam Chukwuweike U, Mistry Jaydev B, Mohamed Nequesha S, Thomas Melbin, Bigart Kevin C, Mont Michael A, Delanois Ronald E
Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland.
Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio.
J Arthroplasty. 2017 Jul;32(7):2088-2092. doi: 10.1016/j.arth.2017.02.046. Epub 2017 Feb 27.
Despite the excellent outcomes associated with primary total hip arthroplasty (THA), implant failure and revision continues to burden the healthcare system. THA failure has evolved and displays variability throughout the literature. In order to understand how THAs are failing and how to reduce this burden, it is essential to assess modes of implant failure on a large scale. Thus, we report: (1) etiologies for revision THA; (2) frequencies of revision THA procedures; (3) patient demographics, payor type, and US Census region of revision THA patients; and (4) the length of stay and total costs based on the type of revision THA procedure.
We queried the National Inpatient Sample database for all revision THA procedures performed between January 1, 2009 and December 31, 2013. This yielded 258,461 revision THAs. Patients specific demographics were identified in order to determine the prevalence of revision procedure performed.
Dislocation was the main indication for revision THA (17.3%), followed by mechanical loosening (16.8%). All-component revision was the most common procedure performed (41.8%). Patients were most commonly white (77.4%), aged 75 years and older (31.6%), and resided in the South US Census region (37.0%). The average length of stay for all procedures was 5.29 days. The mean total charge for revision THA procedures was $77,851.24.
Dislocation and mechanical loosening is the predominant indication for revision THA in the United States. With the frequency of revision THAs projected to double in the next decade, orthopedists must take steps to mitigate this potentially devastating complication.
尽管初次全髋关节置换术（THA）取得了优异的治疗效果，但植入物失败及翻修手术仍给医疗系统带来负担。THA失败情况不断演变，且在整个文献中表现出差异。为了解THA失败的方式以及如何减轻这一负担，大规模评估植入物失败模式至关重要。因此，我们报告：（1）翻修THA的病因；（2）翻修THA手术的频率；（3）翻修THA患者的人口统计学特征、支付方类型及美国人口普查区域；（4）基于翻修THA手术类型的住院时间和总费用。
我们查询了国家住院患者样本数据库中2009年1月1日至2013年12月31日期间进行的所有翻修THA手术。共获得258,461例翻修THA病例。确定了患者的具体人口统计学特征，以确定翻修手术的发生率。
脱位是翻修THA的主要原因（17.3%），其次是机械性松动（16.8%）。全组件翻修是最常见的手术方式（41.8%）。患者以白人为主（77.4%），年龄在75岁及以上（31.6%），居住在美国人口普查南部地区（37.0%）。所有手术的平均住院时间为5.29天。翻修THA手术的平均总费用为77,851.24美元。
在美国，脱位和机械性松动是翻修THA的主要原因。鉴于预计未来十年翻修THA的频率将翻倍，骨科医生必须采取措施减轻这一潜在的灾难性并发症。
