Prevalence of primary and revision total hip and knee arthroplasty in the United States from 1990 through 2002
Prevalence of primary and revision total hip and knee arthroplasty in the United States from 1990 through 2002
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DOI：
10.2106/jbjs.d.02441
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发表时间：
2005-07-01
影响因子：
5.3
通讯作者：
Halpern, M
中科院分区：
文献类型：
--
作者：
Kurtz, S;Mowat, F;Halpern, M
背景：这项研究的目的是量化美国全髋关节和膝关节置换手术的发生率和翻修负担，并确定基于年龄或性别的程序率和总体翻修负担是否随着时间的推移而变化。方法：利用美国全国医院出院调查(NHDS)和美国人口普查数据，使用美国矫形外科医师学会公布的方法，量化美国境内初次和翻修人工关节置换率与年龄和性别的函数关系。Poisson回归分析用于评估手术成功率，并确定初次和翻修人工关节置换率随年龄和性别的逐年变化趋势。结果：1990-2002年间，全髋关节和膝关节置换术(尤其是膝关节置换术)的数量和比率均稳步上升。13年来，每10万人的初次全髋关节置换率增加了约50%，而初次全膝关节置换术的相应比率几乎增加了两倍。每10年每10万人翻修全髋关节成形术3.7例，每10年翻修全膝关节成形术5.4例。然而，全髋关节置换术17.5%的平均翻修负担是全膝关节置换术(8.2%)的两倍多，随着时间的推移，这一点并没有发生实质性的变化。结论：1990-2002年间，美国初次髋关节和膝关节置换术的数量和流行率大幅增加，但初次全膝关节置换术的趋势更为明显。临床相关性：报告的流行趋势对骨科医生未来预期进行的关节置换术的数量有重要影响。由于修订负担随着时间的推移一直相对不变，我们可以预期，除非能够成功地实施某种限制机制以减轻未来的修订负担，否则更多的初级替换将导致更多的修订。
Background: The purpose of this study was to quantify the procedural rate and revision burden of total hip and knee arthroplasty in the United States and to determine if the age or gender-based procedural rates and overall revision burden are changing over time.Methods: The National Hospital Discharge Survey (NHDS) for 1990 through 2002 was used in conjunction with United States Census data to quantify the rates of primary and revision arthroplasty as a function of age and gender within the United States with use of methodology published by the American Academy of Orthopaeclic Surgeons. Poisson regression analysis was used to evaluate the procedural rate and to determine year-to-year trends in primary and revision arthroplasty rates as a function of both age and gender.Results: Both the number and the rate of total hip and knee arthroplasties (particularly knee arthroplasties) increased steadily between 1990 and 2002. Over the thirteen years, the rate of primary total hip arthroplasties per 100,000 persons increased by approximately 50%, whereas the corresponding rate of primary total knee arthroplasties almost tripled. The rate of revision total hip arthroplasties increased by 3.7 procedures per 100,000 persons per decade, and that of revision total knee arthroplasties, by 5.4 procedures per 100,000 persons per decade. However, the mean revision burden of 17.5% for total hip arthroplasty was more than twice that for total knee arthroplasty (8.2%), and this did not change substantially over time.Conclusions: The number and prevalence of primary hip and knee replacements increased substantially in the United States between 1990 and 2002, but the trend was considerably more pronounced for primary total knee arthroplasty.Clinical Relevance: The reported prevalence trends have important ramifications with regard to the number of joint-replacements expected to be performed by orthopaedic surgeons in the future. Because the revision burden has been relatively constant over time, we can expect that a greater number of primary replacements will result in a greater number of revisions unless some limiting mechanism can be successfully implemented to reduce the future revision burden.