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From Reuters Health Information

Experienced Surgeons Do Fewer Hip Replacements That Need Revision

By Fran Lowry (source – click here)

NEW YORK (Reuters Health) Feb 18 – Three factors predict higher odds that a hip replacement will need revision within 12 years: male gender, age less than 75, and having a surgeon who does no more than a dozen such cases a year, according to a new analysis of Medicare claims data.

“Not much is known about the risk of revision surgery over this long period of time,” Dr. Jeffrey N. Katz, from Harvard Medical School, Boston, told Reuters Health. “There is a lot of work from individual centers but those are not always reflective of what happens in the population at large.”

In a study presented this week at the annual meeting of the American Academy of Orthopaedic Surgeons, Dr. Katz and colleagues identified 58,521 Medicare patients who had primary total hip replacement in 1995-1996, at an average age of 74 (range, 68 to 80). They followed this cohort until 2008.

Most (64%) were female, and 56% used surgeons who did fewer than 12 hip replacement surgeries per year.

Over the 12- to 13-year follow up, 32,680 patients died and 4,830 had revision total hip replacement.

On multivariate analysis adjusted for age, gender, race, Medicaid eligibility (a proxy for income), diagnosis, comorbidity, surgeon and hospital volume for the procedure, the researchers found that age 65 to 75 years was associated with a significantly higher risk of revision compared with age over 75 (hazard ratio 1.45).

Male gender had a hazard ratio for revision of 1.23; for surgeon volume less than 12 cases per year the hazard ratio was 1.22.

Perhaps not surprisingly, considering the age of the patients, the study also showed that the risk of dying over the follow-up period was higher than the risk of having a revision surgery.

“Most people are eventually survived by their prostheses,” Dr. Katz said. “Only 6% of people who are older than 75 had to have a revision during their lifetime.”

“People often want to know if they will need a revision so this is important information,” he added. “It appears that if you are older, you don’t have to worry.”

In their abstract for the meeting, the investigators say the findings point to the need for more research on revision rates in patients younger than 65.

“Younger patients would very likely live long enough to need a revision. If one were going to develop a new prosthesis that lasts longer, it would probably make more sense to develop one for younger patients rather than for older patients, who are probably going to be fine with a standard prosthesis,” Dr. Katz said.


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