The burden of prosthetic hip dislocations in the United States is projected to significantly increase by 2035

Abstract

Introduction: Prosthetic hip dislocation is a common, costly complication of total hip arthroplasty (THA). Despite this, the national burden of prosthetic hip dislocations remains uncharacterised in the United States, especially pertaining to injuries occurring years after the index procedure. This study examines historical and projected national estimates of prosthetic hip dislocations presenting to U.S. emergency departments between 2000 and 2035. Methods: We conducted a cross-sectional, retrospective epidemiological study using narratives in the National Electronic Injury Surveillance System (NEISS) database (2000–2017) to identify an estimated 64,671 prosthetic hip implant dislocations presenting to U.S. emergency departments. Estimates for the prevalence of individuals living with a total hip implant were derived from the literature. Results: The national estimate of prosthetic hip dislocations presenting to U.S. emergency departments rose significantly ( p < 0.001) between 2000 ( n = 2395; 95% CI, 1264–3526) and 2017 ( n = 8094; 95% CI, 4276–11,912). These increases are likely driven by increased numbers of people living with THA overall, since between 2000 and 2017, the average incidence of prosthetic hip dislocation (0.14%; CI 0.08–0.21%) in patients living with hip implants has not changed significantly. Linear regression modeling (R2 = 0.7, p < 0.01) projected an increasing number of dislocations through 2035, predicting 10,446 national cases per year by this date. Conclusions: Driven by increases in THA, the annual volume of prosthetic hip dislocations presenting to U.S. emergency departments has increased significantly since 2000 and is projected to continue to rise sharply. Future advances in surgical technique, prosthesis design, and injury prevention policies aimed at decreasing the rate of THA dislocation would help alleviate this mounting national health burden.

Healthcare resource utilization and costs for hip dislocation following primary total hip arthroplasty in the medicare population

“…Implant modifications, such as large femoral heads to improve stability, porous metals to enhance fixation, and alternative bearings to improve wear, have been introduced in order to decrease the rate of early and late failures. [9,17] Despite the lower rate per patient with THA, dislocation after primary THA continues to be a prevalent and costly complication that diminishes the cost-effectiveness of an otherwise very successful surgical procedure. [5] The annual volume of prosthetic hip dislocations presenting to US emergency departments has increased significantly since 2000 due to the increase in THAs, and it is projected to continue to rise sharply.…”

“…[5] The annual volume of prosthetic hip dislocations presenting to US emergency departments has increased significantly since 2000 due to the increase in THAs, and it is projected to continue to rise sharply. [9] Additional advances in surgical technique, prosthesis design, and injury prevention policies aimed at decreasing the rate of THA dislocation would help alleviate this significant and increasing national health burden. [9] The findings of the current large U.S. retrospective database evaluation affirmed the substantial HCRU and cost burden of hip dislocation associated with THA.…”

“…[9] Additional advances in surgical technique, prosthesis design, and injury prevention policies aimed at decreasing the rate of THA dislocation would help alleviate this significant and increasing national health burden. [9] The findings of the current large U.S. retrospective database evaluation affirmed the substantial HCRU and cost burden of hip dislocation associated with THA. The proportion of patients with utilization, the mean number of days of service, and the claims payments amounts for THA hospitalization, home health agency, skilled nursing facility, inpatient rehabilitation facility, other inpatient admission, long-term care hospital, and outpatient care were statistically significantly greater for patients with THA dislocation vs. patients without THA dislocation.…”

“…[18] Future advances aimed at decreasing the rate of THA dislocation could help alleviate these concerns and burdens. [9] A strength of the current study design is the use of direct matching for the year of THA, surgeon, and the hospital for THA. This level of matching was possible due to the significant size of the Medicare database.…”

“…The focus within some of these studies and awareness externally by healthcare providers is on the cost of revision; however, revision after THA dislocation will only occur in some instances, and patients and healthcare systems are burdened by both revision and non-revision treatments for THA dislocation. [9] Evidence documenting the healthcare resource utilization (HCRU) and cost of nonrevision or conservative treatments is scarce. No studies identified in the published medical literature used real-world evidence sources such as Medicare to quantify non-revision inpatient and hospitalbased HCRU and costs following THA dislocation.…”