Instability Is the Most Common Indication for Revision Hip Arthroplasty in the United States: National Trends From 2012 to 2018

Abstract

Background As primary total hip arthroplasty volume continues to increase, so will the number of revision total hip arthroplasty (rTHA) procedures. These complex cases represent a significant clinical and financial burden to the health-care system. Methods This was a retrospective review using the National Inpatient Sample. International Classification of Diseases, 9th and 10 th revision codes were used to identify patients who underwent rTHA and create cohorts based on rTHA indications from 2012 to 2018. National and regional trends for length of stay (LOS), cost, and discharge location were evaluated. Results A total of 292,250 rTHA procedures were identified. The annual number of rTHA procedures increased by 28.1% from 2012 to 2018 (37,325 to 47,810). The top 3 indications for rTHA were instability (20.4%), aseptic loosening (17.8%), and infection (11.1%). Over the study period, the proportion of patients discharged to skilled nursing facility decreased from 44.2% to 38% ( P < .001). Hospital LOS decreased on average from 4.8 to 4.4 days ( P < .001). Infections had the highest average LOS (7.3 days) followed by periprosthetic fractures (6.5 days). Hospital costs decreased over the study period, from $25,794 to $24,555 ( P < .001). The proportion of rTHA cases performed at urban academic centers increased (58.0% to 75.3%, P < .001) while the proportion performed at urban nonacademic centers decreased (35.5% to 19.4%, P < .001). Conclusion Instability was the most common indication for rTHA between 2012 and 2018. The proportion of rTHA performed in urban academic centers has increased substantially, away from urban nonacademic centers. While cost and LOS have decreased, significant geographic variability exists.

Epidemiology of Revision Total Knee Arthroplasty in the United States, 2012 to 2019

“…Patients with tibia and femur revision procedure codes reported separately were classified as a revision of both components. These patients were then grouped based on the specific indication for rTKA ( Table S1 ) [ 25 ]. The first related diagnostic code listed was used as the primary indication for rTKA.…”

Revision Total Hip Arthroplasty in Solid Organ Transplant Patients: A Propensity Score-Matched Cohort Study for Aseptic and Infected Revisions

“…Patients were identified using the International Classification of Diseases, ninth and tenth revision, (ICD-9 and ICD-10) procedure codes ( Table 1 ). For ICD-10 procedure codes, patients required either a revision code or a relevant removal and replacement code as described [ 13 ]. Patients were separated into groups based on whether or not they had a diagnosis of SOT ( Table 1 ).…”

2021 AAHKS Symposium: The Painful Total Hip Arthroplasty: “Looks Good but Feels Bad”

“…In that sample of 292,250 revision THAs, the 3 most common identified indications for revision THA were instability (20.4%), aseptic loosening (17.8%), and infection (11.1%). However, over that study period of 2012 to 2018, the greatest percentage of revision THA diagnosis was in the "other" category at 23.5% [1]. Interestingly, in a prior study of the National Inpatient Sample of 258,461 revision THAs from 2009 to 2013, instability (17.3%), mechanical loosening (16.8%), "other" (16.0%), and infection (12.8%) constituted the top 4 diagnoses [2].…”

“…As the number of THAs continues to increase, the overall burden of revision THA will subsequently continue to increase. In a recent query of the National Inpatient Sample, Upfill-Brown et al [1] reported that revision THA procedures increased by 28.1% from 2012 to 2018. In that sample of 292,250 revision THAs, the 3 most common identified indications for revision THA were instability (20.4%), aseptic loosening (17.8%), and infection (11.1%).…”