Madhok R, Lewallen D G, Wallrichs S L, Ilstrup D M, Kurland R L, Melton L J
Section of Clinical Epidemiology, Mayo Clinic, Rochester, MN 55905.
Mayo Clin Proc. 1993 Jan;68(1):11-8. doi: 10.1016/s0025-6196(12)60013-5.
Using the unique data resources of the Rochester Epidemiology Project, we identified the residents of Olmsted County, Minnesota, who underwent total hip arthroplasty (THA) between 1969, when this technique was introduced, and 1990. During this period, 735 residents underwent 859 primary THAs. An initial dramatic upsurge in utilization of THA soon after its introduction was followed by a lower rate of increase, to an age- and sex-adjusted rate of 59.9 per 100,000 person-years in 1987 through 1990. In Olmsted County, the procedure was used more often in women than in men, but men underwent THA at a younger age than did women. THAs were performed for various conditions of the hip, but the increased utilization during the last decade of the study was mainly attributable to its application in primary degenerative hip disease among patients (male more often than female) from a wider age range; utilization of THA for hip fractures decreased during the study period. Most THAs were of the cemented variety (86.1%); however, the rate of use of noncemented THAs, first performed in 1984, is increasing. The overall upward trend in Olmsted County was consistent with European data but less than the rate of increase observed for the United States as a whole between 1983 and 1987. Olmsted County utilization rates, if projected nationally, suggest a need for more than 139,000 primary THAs each year at an annual direct cost of more than $2.7 billion. An urgent need exists for detailed examination of national utilization patterns and clarification of the role of cementless implants and of THA for hip fractures.
利用罗切斯特流行病学项目的独特数据资源，我们确定了明尼苏达州奥尔姆斯特德县在1969年（该技术引入之年）至1990年间接受全髋关节置换术（THA）的居民。在此期间，735名居民接受了859例初次全髋关节置换术。全髋关节置换术引入后，其使用量最初急剧上升，随后增速放缓，1987年至1990年经年龄和性别调整后的发生率为每10万人年59.9例。在奥尔姆斯特德县，该手术在女性中的使用频率高于男性，但男性接受全髋关节置换术的年龄比女性小。全髋关节置换术用于治疗各种髋关节疾病，但在研究的最后十年中使用量的增加主要归因于其在更广泛年龄范围的患者（男性比女性更常见）原发性退行性髋关节疾病中的应用；在研究期间，用于髋部骨折的全髋关节置换术使用率下降。大多数全髋关节置换术采用骨水泥型（86.1%）；然而，1984年首次开展的非骨水泥型全髋关节置换术的使用率正在上升。奥尔姆斯特德县的总体上升趋势与欧洲数据一致，但低于1983年至1987年美国整体观察到的增长率。如果将奥尔姆斯特德县的使用率推算至全国，表明每年需要超过139,000例初次全髋关节置换术，每年直接成本超过27亿美元。迫切需要详细审查全国的使用模式，并阐明非骨水泥植入物的作用以及全髋关节置换术用于髋部骨折的情况。
