The Journal of Hip Surgery 2017; 01(02): 112-117
DOI: 10.1055/s-0037-1604030
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Trends in Hip Resection Arthroplasty in the Medicare Patient Population from 2005 to 2012

Omri Merose
1   Department of Orthopedics and Rehabilitation, University of Miami, Miami, Florida
,
Erik Zachwieja
1   Department of Orthopedics and Rehabilitation, University of Miami, Miami, Florida
,
Samuel Rosas
1   Department of Orthopedics and Rehabilitation, University of Miami, Miami, Florida
2   Department of Orthopedic Surgery, Holy Cross Hospital, Fort Lauderdale, Florida
,
Jennifer Kurowicki
1   Department of Orthopedics and Rehabilitation, University of Miami, Miami, Florida
,
Luis C. Grau
1   Department of Orthopedics and Rehabilitation, University of Miami, Miami, Florida
,
Victor H. Hernandez
1   Department of Orthopedics and Rehabilitation, University of Miami, Miami, Florida
› Author Affiliations
Further Information

Publication History

04 May 2017

30 May 2017

Publication Date:
26 June 2017 (online)

Abstract

Hip resection arthroplasty (HRA) is a relatively uncommon, yet viable surgical procedure originally developed by Girdlestone for osteomyelitis of the proximal femur. Currently, HRA is primarily indicated as a salvage procedure after a failed total hip arthroplasty. Despite a continuous rise in the rates of primary and revision hip arthroplasty, there is a lack of published evidence regarding the extent of HRA's current use and its recent trends. We sought to provide an epidemiological description of the recent utilization patterns of HRA in the United States. A level of evidence IV, retrospective case series review of the entire Medicare files between 2005 and 2012 was conducted through the use of current procedural terminology codes and International Classification of Disease ninth edition codes. Linear regressions and chi-square tests were used for analysis. Subgroup analysis was performed by patient age. The total number of HRAs performed between 2005 and 2012 significantly decreased from 4,248 to 3,872 (p = 0.025). There was a significant increase in the annual incidence of HRA among patients younger than 65 years (p = 0.027; 9% increase) and patients 65 to 69 years old (p = 0.007; 22% increase), constituting 43% of the total patients. There was a significant decrease in HRA incidence among patients 80 to 84 years old (p = 0.001; 32% decrease) and patients 85 years old and over (p = 0.002; 24% decrease). Geographic analysis demonstrated the most HRA procedures were performed in the South, whereas gender focused analysis demonstrated a statistically significant decrease in HRA incidence for females (p = 0.003; 6% decrease) and a significant increase in incidence for males (p = 0.003; 7% increase). The overall annual incidence of HRA performed in the Medicare patient population has significantly decreased in recent years. However, this conceals an increased incidence among the relatively younger patient population. Potential causes for these opposing trends include changes in rates of revision surgery, alternative indications for surgery, advances in hardware, and surgeon expertise. This was a level of evidence IV, retrospective case series study.

 
  • References

  • 1 Girdlestone G. Arthrodesis and other operations for tuberculosis of the hip. In: Milford H. , ed. The Robert Jones Birthday Volume. London: Oxford University Press; 1928: 347-374
  • 2 Girdlestone GR. Operative treatment in tuberculosis of the larger joints. BMJ 1929; 2 (3585): 529-532
  • 3 Girdlestone G. Acute pyogenic arthritis of the hip: an operation giving free access and effective drainage. Lancet 1943; 241 (6240): 419-421
  • 4 Scott JC. Pseudarthrosis of the hip. Clin Orthop Relat Res 1963; 31 (31) 31-38
  • 5 Girdlestone GR. Acute pyogenic arthritis of the hip: an operation giving free access and effective drainage. 1943. Clin Orthop Relat Res 2008; 466 (02) 258-263
  • 6 Rubin LE, Murgo KT, Ritterman SA, McClure PK. Hip resection arthroplasty. JBJS Rev 2014 2. (05):01874474-201402050-00003
  • 7 Fisman DN, Reilly DT, Karchmer AW, Goldie SJ. Clinical effectiveness and cost-effectiveness of 2 management strategies for infected total hip arthroplasty in the elderly. Clin Infect Dis 2001; 32 (03) 419-430
  • 8 Maradit Kremers H, Larson DR, Crowson CS. , et al. Prevalence of total hip and knee replacement in the United States. J Bone Joint Surg Am 2015; 97 (17) 1386-1397
  • 9 Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am 2007; 89 (04) 780-785
  • 10 Malcolm TL, Gad BV, Elsharkawy KA, Higuera CA. Complication, survival, and reoperation rates following Girdlestone resection arthroplasty. J Arthroplasty 2015; 30 (07) 1183-1186
  • 11 Issa K, Banerjee S, Kester MA, Khanuja HS, Delanois RE, Mont MA. The effect of timing of manipulation under anesthesia to improve range of motion and functional outcomes following total knee arthroplasty. J Bone Joint Surg Am 2014; 96 (16) 1349-1357
  • 12 Oheim R, Gille J, Schoop R. , et al. Surgical therapy of hip-joint empyema. Is the Girdlestone arthroplasty still up to date?. Int Orthop 2012; 36 (05) 927-933
  • 13 Sharma H, De Leeuw J, Rowley DI. Girdlestone resection arthroplasty following failed surgical procedures. Int Orthop 2005; 29 (02) 92-95
  • 14 Castellanos J, Flores X, Llusà M, Chiriboga C, Navarro A. The Girdlestone pseudarthrosis in the treatment of infected hip replacements. Int Orthop 1998; 22 (03) 178-181
  • 15 Murray WR, Lucas DB, Inman VT. Femoral head and neck resection. J Bone Joint Surg Am 1964; 46: 1184-1197
  • 16 McElwaine JP, Colville J. Excision arthroplasty for infected total hip replacements. J Bone Joint Surg Br 1984; 66 (02) 168-171
  • 17 Bittar ES, Petty W. Girdlestone arthroplasty for infected total hip arthroplasty. Clin Orthop Relat Res 1982; (170) 83-87
  • 18 Palazzo C, Jourdan C, Descamps S. , et al. Determinants of satisfaction 1 year after total hip arthroplasty: the role of expectations fulfilment. BMC Musculoskelet Disord 2014; 15: 53
  • 19 Tilbury C, Haanstra TM, Leichtenberg CS. , et al. Unfulfilled expectations after total hip and knee arthroplasty surgery: there is a need for better preoperative patient information and education. J Arthroplasty 2016; 31 (10) 2139-2145
  • 20 Bozic KJ, Kamath AF, Ong K. , et al. Comparative epidemiology of revision arthroplasty: failed THA poses greater clinical and economic burdens than failed TKA. Clin Orthop Relat Res 2015; 473 (06) 2131-2138
  • 21 Ong KL, Lau E, Suggs J, Kurtz SM, Manley MT. Risk of subsequent revision after primary and revision total joint arthroplasty. Clin Orthop Relat Res 2010; 468 (11) 3070-3076
  • 22 Bourne RB, Maloney WJ, Wright JG. An AOA critical issue. The outcome of the outcomes movement. J Bone Joint Surg Am 2004; 86-A (03) 633-640
  • 23 Eslam Pour A, Bradbury TL, Horst PK, Harrast JJ, Erens GA, Roberson JR. Trends in primary and revision hip arthroplasty among orthopedic surgeons who take the American Board of Orthopedics Part II Examination. J Arthroplasty 2016; 31 (07) 1417-1421
  • 24 Khatod M, Cafri G, Namba RS, Inacio MC, Paxton EW. Risk factors for total hip arthroplasty aseptic revision. J Arthroplasty 2014; 29 (07) 1412-1417
  • 25 Bolland BJ, Culliford DJ, Langton DJ, Millington JP, Arden NK, Latham JM. High failure rates with a large-diameter hybrid metal-on-metal total hip replacement: clinical, radiological and retrieval analysis. J Bone Joint Surg Br 2011; 93 (05) 608-615
  • 26 Hwang JH, Varte L, Kim HW, Lee DH, Park H. Salvage procedures for the painful chronically dislocated hip in cerebral palsy. Bone Joint J 2016; 98-B (01) 137-143
  • 27 Kolman SE, Ruzbarsky JJ, Spiegel DA, Baldwin KD. Salvage options in the cerebral palsy hip: a systematic review. J Pediatr Orthop 2016; 36 (06) 645-650
  • 28 Allison DC, Holtom PD, Patzakis MJ, Zalavras CG. Microbiology of bone and joint infections in injecting drug abusers. Clin Orthop Relat Res 2010; 468 (08) 2107-2112
  • 29 Kak V, Chandrasekar PH. Bone and joint infections in injection drug users. Infect Dis Clin North Am 2002; 16 (03) 681-695
  • 30 McAuley JP, Szuszczewicz ES, Young A, Engh Sr CA. Total hip arthroplasty in patients 50 years and younger. Clin Orthop Relat Res 2004; (418) 119-125
  • 31 Karam JA, Tokarski AT, Ciccotti M, Austin MS, Deirmengian GK. Revision total hip arthroplasty in younger patients: indications, reasons for failure, and survivorship. Phys Sportsmed 2012; 40 (04) 96-101
  • 32 Prokopetz JJ, Losina E, Bliss RL, Wright J, Baron JA, Katz JN. Risk factors for revision of primary total hip arthroplasty: a systematic review. BMC Musculoskelet Disord 2012; 13: 251
  • 33 Schwartz BE, Piponov HI, Helder CW, Mayers WF, Gonzalez MH. Revision total hip arthroplasty in the United States: national trends and in-hospital outcomes. Int Orthop 2016; 40 (09) 1793-1802
  • 34 Centers for Medicare and Medicaid Services. Medicare Fee-for-Service. 2012 Improper Payments Report. Available at https://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/CERT/Downloads/MedicareFeeforService2012ImproperPaymentsReport.pdf . Accessed March 9, 2016
  • 35 Barrack RL, Aggarwal A, Burnett RS. Resection arthroplasty: when enough is enough. Orthopedics 2006; 29 (09) 820-821