Temporal trends and survivorship of total hip arthroplasty in very young patients: a study using the National Joint Registry data set.

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Abstract

[Indexed for MEDLINE] 6. J Arthroplasty. 2016 Sep;31(9 Suppl):63-8. doi: 10.1016/j.arth.2016.01.061. Epub 2016 Apr 2. National Trends in Primary Total Hip Arthroplasty in Extremely Young Patients: A Focus on Bearing Surface Usage From 2009 to 2012. Rajaee SS(1), Theriault RV(2), Pevear ME(2), Smith EL(2). Author information: (1)Department of Orthopaedics, Cedars-Sinai Medical Center, Los Angeles, California. (2)Department of Orthopaedics, Tufts University School of Medicine, Boston, Massachusetts. BACKGROUND: The ideal bearing surface for primary total hip arthroplasty (THA) in young patients remains a debate. Data on recent national trends are lacking. The purpose of this study is to provide an analysis on the national epidemiologic trends of bearing surface usage in patients aged ≤30 years undergoing THA from 2009 through 2012. METHODS: Using the Healthcare Cost and Utilization Project Nationwide Inpatient Sample from 2009 to 2012, 9265 THA discharges (4210 coded by bearing surface) were identified in patients aged ≤30 years. Prevalence of surface type was analyzed along with patient and hospital demographic data. Statistical analysis was performed using SAS (SAS version 9.1; SAS, Inc, Cary, NC). Significance was set at P < .05. RESULTS: Ceramic-on-polyethylene (CoP) bearing surfaces were most commonly used, representing 35.6% of cases, followed by metal-on-polyethylene (MoP; 28.0%), metal-on-metal (MoM; 19.3%), and ceramic-on-ceramic (CoC; 17.0%) bearing surfaces. Hard-on-hard bearing surfaces (MoM and CoC) represented only 36.4% of cases, a significant decrease from previously reported findings (2006-2009) where hard-on-hard bearing surfaces were the majority (62.2%; P < .05). Hard-on-hard bearing surface usage decreased from 2009 to 2012 (MoM: 29.7% to 10.2%; CoC: 20.0% to 14.7%), whereas hard-on-soft bearing surface usage (MoP and CoP) increased. CoP bearing surfaces saw the most significant increase from 25.7% in 2009 to 48.2% in 2012. A cost analysis revealed that CoP discharges were associated with higher hospital charges than other surface types, with an average charge of $66,457 (P < .05). CONCLUSION: Use of hard-on-hard surfaces has decreased significantly in this population, whereas CoP and MoP surfaces have become increasingly common. Determining the optimal bearing surface for extremely young patients continues to be a challenge for orthopedic surgeons as they weigh the risks and benefits of each. Copyright © 2016 Elsevier Inc. All rights reserved. DOI: 10.1016/j.arth.2016.01.061