Endres Heinz, Schneider Olaf, Scharf Hanns-Peter, Kaufmann-Kolle Petra, Knapstein Sabine, Hermann Christopher, Lembeck Burkhard, Flechtenmacher Johannes
Patientensicherheit und Arzneimittel, aQua-Institut Göttingen, Deutschland.
Fachbereich Versorgungs-Controlling und Analytik, AOK Baden-Württemberg Hauptverwaltung, Stuttgart, Deutschland.
Z Orthop Unfall. 2018 Dec;156(6):672-684. doi: 10.1055/a-0648-4945. Epub 2018 Oct 26.
Due to demographic changes an increasing number of hip osteoarthritis can be expected with corresponding effects on the health care system. Hence, the objectives of our study were to obtain substantiated evidence about current medical care situation of hip osteoarthritis patients including outpatient care situation and hip replacement surgery.
Overall, the medical care data of 2.4 million insurees of the AOK Baden-Württemberg for the years 2007 to 2016 were analyzed. Lower limit of age was 40 years. The data includes outpatient and inpatient healthcare claims.
The age standardized prevalence of hip osteoarthritis in adults aged 40 years or older is 6.18% (95% CI: ± 0.09%) among women and 6.02% (95% CI: ± 0.09%) among men. From the age of 75, sex differences become significant. The maximum number of newly diagnosed cases of hip osteoarthritis (women: 1.31%, men: 1.16%) is found in the 80 - 84-year-olds. From the age of 85, 17.4% of all women and 16.5% of all men show a hip osteoarthritis. The maximum number of hip replacement surgery among osteoarthritis patients (women: 5.2%, men: 4.3%) appears in the 75- to 79-year-olds. After the initial diagnosis of a hip osteoarthritis, every eighth (13.0%) AOK insured person receives a hip replacement surgery within the first year and one in four (24.8%) insurees within 8 years. Irrespective of the main diagnosis, numbers of hip replacement surgery did not increase between 2009 and 2016. On average, 300.9 (women) and 275.8 (men) hip replacement surgeries were performed per 100 000 insured years. From the age of 80, hip osteoarthritis drops back as the main diagnosis fur surgery. Consequently, from the age of 85 more than 70% of all hip replacement patients show a femoral fracture as main diagnosis. Only about ¾ of the hip osteoarthritis patients were in outpatient specialist care in the year before surgery, and far less than half of hip osteoarthritis patients received a referral to physiotherapy.
Osteoarthritis of the hip occurs approximately equally often in women and men up to the age of 75 years. Nevertheless, women underwent surgery more frequently. Overall, the number of hip replacement surgery has not increased in the last eight years. Within the first eight years after initial diagnosis of hip osteoarthritis 24.8% of all patients receive a hip TEP. Hence, the majority of patients is treated conservatively in the first eight years. A direct comparison between incidence and prevalent hip osteoarthritis patients reveals that after many years of therapeutic care in the last 1 - 2 years prior to surgery, both the specialist care as well as the referral to physiotherapy are reduced. A reassessment of conservative treatment options over time seems to be necessary.
由于人口结构变化，预计髋骨关节炎患者数量将增加，这将对医疗保健系统产生相应影响。因此，我们研究的目的是获得关于髋骨关节炎患者当前医疗状况的实证证据，包括门诊护理情况和髋关节置换手术。
总体而言，分析了2007年至2016年德国巴登-符腾堡州AOK的240万参保人的医疗数据。年龄下限为40岁。数据包括门诊和住院医疗费用报销。
40岁及以上成年人中，髋骨关节炎的年龄标准化患病率在女性中为6.18%（95%置信区间：±0.09%），在男性中为6.02%（95%置信区间：±0.09%）。从75岁起，性别差异变得显著。髋骨关节炎新诊断病例数最多的年龄段（女性：1.31%，男性：1.16%）为80 - 84岁。85岁及以上的女性中，17.4%患有髋骨关节炎，男性中这一比例为16.5%。骨关节炎患者中髋关节置换手术数量最多的年龄段（女性：5.2%，男性：4.3%）为75 - 79岁。在初次诊断为髋骨关节炎后，每八分之一（13.0%）的AOK参保人在第一年内接受髋关节置换手术，四分之一（24.8%）的参保人在8年内接受手术。无论主要诊断如何，2009年至2016年间髋关节置换手术数量均未增加。每10万参保年平均进行300.9例（女性）和275.8例（男性）髋关节置换手术。从80岁起，髋骨关节炎作为主要手术诊断的比例下降。因此，85岁及以上的所有髋关节置换患者中，超过70%的主要诊断为股骨骨折。手术前一年，只有约四分之三的髋骨关节炎患者接受门诊专科护理，接受物理治疗转诊的髋骨关节炎患者远少于一半。
75岁之前，髋骨关节炎在女性和男性中的发病率大致相同。然而，女性接受手术的频率更高。总体而言，过去八年中髋关节置换手术数量并未增加。在初次诊断为髋骨关节炎后的前八年，所有患者中有24.8%接受了髋关节置换手术。因此，大多数患者在最初的八年中接受保守治疗。对发病率和现患髋骨关节炎患者的直接比较显示，在手术前的最后1 - 2年经过多年治疗后，专科护理以及物理治疗转诊都减少了。随着时间的推移，似乎有必要重新评估保守治疗方案。
