To Identify Related Factors on the Revision of Total Hip Replacements of the Avascular Necrotic Hip －cohort study using national health insurance enrollees in Taiwan
Date Issued
2011
Date
2011
Author(s)
Lin, Tzu-Chieh
Abstract
Background and purposeSurvival rate of total hip prosthesis has been considered to be poor in the patients of avascular necrosis of hip in past two decades. The purpose of this study was to investigate the revision rate of a large total hip replacement cohort of avascular necrosis of hip in patient less than 70 years of age, specifically any differences between the prosthesis brands and to analyz the factors affecting revision.
Patients and methods Between 1996 and1998,all national health insurance enrollees whose insurance claims records have total hip arthroplasties（ICD-9-CM procedure code 81.51）were analyzed. The study cohort was the diagnostic subgroup of avascular necrotic hip（ICD-9-CM disease code 733.42）with the age less than 70-year-old. Kaplan-Meier survival analysis with the date of revision of any component, orDec. 31,2007, as the endpoints was performed. Cox regression models were used to calculate risk ratios for revision of total hip replacement for various reasons, adjusted for sex, age, hospital level, orthopedic surgeon of 3-year surgery volume
ResultsThe rate of avascular necrotic hip in the causes of total hip arthroplasty was 46.2%. The cumulative revision rate of the cohort was 0.3% in 3 years, 0.7% in 5 years and 2.9% in 10years. Nodifference in 10-year cumulative revision rate wasnoted in sex, hospital level or orthopedic surgeon of 3-year surgery volume groups. Cox regression analysis confirmed that 60-64 year-old group had a highest risk of revision for any reason (RR=3.6, 95% CI: 1.0-12.8) , whereas 40-44 year-old group had a higher risk of revision for any reason (RR=3.4, 95% CI: 1.0-11.6). In Taiwan, six most common used prosthesis brands included 7 types of prosthesis designs, at least. There were 2 types of hydroxylapatite coating designs with a higher risk of revision (4120NH1，RR= 6.0，95％CI：1.4-25.8；1000NS2，RR= 4.6，95％CI：1.1-19.9).Another brand of prosthesis, in general, also had a higher risk(1000NC2，RR= 5.2，95％CI：1.3〜21.9). However, all the prostheses had a 10-years revision rate less than 5%.
InterpretationThe performance of modern second-generation cemented and cementlessprostheses with porous- or hydroxylapatite coating has satisfactorily low 10-year revision rate in the avascular necrotic hip groups of age less than 70-year-old.
Subjects
total hip replacement
revision of total hip replacement
national health insurance research database
survival rate
Type
thesis
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