澳大利亚髋关节翻修手术的终身风险仍然较低：基于国家注册数据库的人群水平分析。

Lifetime Risk of Revision Hip Replacement Surgery in Australia Remains Low: A Population-Level Analysis Using National Registry Data.

机构信息

School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.

South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia.

出版信息

J Bone Joint Surg Am. 2021 Mar 3;103(5):389-396. doi: 10.2106/JBJS.20.01235.

DOI:10.2106/JBJS.20.01235

PMID:33439609

Abstract

BACKGROUND

Well-validated data from arthroplasty registries provide an opportunity to understand contemporary use of revision hip replacement at a national level. Such information can underpin health-care resource allocation and surgical workforce planning. The purposes of the present study were to describe the demographic characteristics of patients managed with revision hip replacement surgery in Australia and to examine changes in the lifetime risk of revision hip replacement over a decade.

METHODS

Deidentified individual-level data on all revision hip replacement procedures performed in Australia from 2007 to 2017 were obtained from the Australian Orthopaedic Association National Joint Replacement Registry. Life tables and population data were sourced from the Australian Bureau of Statistics. The lifetime risk of revision surgery each year was estimated with use of a standardized approach, with separate calculations for males and females.

RESULTS

A total of 46,086 revision hip replacement procedures were performed from 2007 to 2017. The median age at the time of surgery was 72 years (interquartile range, 63 to 80 years). While loosening or lysis became less frequent reasons for revision over time (from 51% in 2007 to 28% in 2017), revision hip replacement for infection became increasingly common (from 14% in 2007 to 25% in 2017). Revisions for metal-related pathology peaked in 2011. Utilization rates were highest for males ≥80 years of age (127.9 procedures per 100,000 population in 2017). Although a small rise was evident in 2011 and 2012 (to 2.39% and 2.22%, respectively), the lifetime risk of revision hip replacement in females decreased from 1.90% (95% confidence interval [CI], 1.82% to 1.99%) in 2007 to 1.74% (95% CI, 1.66% to 1.82%) in 2017. A similar pattern was evident for males; the lifetime risk was 1.78% (95% CI, 1.69% to 1.86%) in 2007 and 1.57% (95% CI, 1.49% to 1.65%) in 2017.

CONCLUSIONS

These data enable us to understand the epidemiology of revision hip replacement in Australia, including the shifting clinical indications for this procedure. At a population level, the lifetime risk of revision hip replacement remains low at <1 in 50 people in 2017. These methods can be utilized for population-level surveillance of revision burden and to enable between-country benchmarking.

LEVEL OF EVIDENCE

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

摘要

背景

关节置换登记处的经过充分验证的数据为了解全国范围内接受翻修髋关节置换手术的患者的当代使用情况提供了机会。此类信息可以为医疗保健资源分配和外科劳动力规划提供依据。本研究的目的是描述澳大利亚接受翻修髋关节置换手术的患者的人口统计学特征，并研究在十年间翻修髋关节置换手术的终生风险的变化。

方法

从澳大利亚骨科协会全国关节置换登记处获得了 2007 年至 2017 年期间在澳大利亚进行的所有翻修髋关节置换手术的匿名个体水平数据。寿命表和人口数据来源于澳大利亚统计局。使用标准化方法估算每年进行翻修手术的终生风险，分别为男性和女性进行单独计算。

结果

2007 年至 2017 年共进行了 46086 例翻修髋关节置换手术。手术时的中位年龄为 72 岁（四分位距，63 岁至 80 岁）。随着时间的推移，松动或溶解的原因逐渐减少（从 2007 年的 51%降至 2017 年的 28%），但感染导致的翻修髋关节置换手术却越来越常见（从 2007 年的 14%增至 2017 年的 25%）。与金属相关的病理学引起的翻修在 2011 年达到高峰。80 岁以上男性的使用率最高（2017 年为每 100000 人中有 127.9 例手术）。尽管 2011 年和 2012 年略有上升（分别达到 2.39%和 2.22%），但女性翻修髋关节置换的终生风险从 2007 年的 1.90%（95%置信区间，1.82%至 1.99%）降至 2017 年的 1.74%（95%置信区间，1.66%至 1.82%）。男性也呈现出类似的模式；2007 年的终生风险为 1.78%（95%置信区间，1.69%至 1.86%），2017 年为 1.57%（95%置信区间，1.49%至 1.65%）。