Risk of complication and revision total hip arthroplasty among Medicare patients with different bearing surfaces.
Risk of complication and revision total hip arthroplasty among Medicare patients with different bearing surfaces.
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DOI：
10.1007/s11999-010-1262-3
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发表时间：
2010-09
影响因子：
4.2
通讯作者：
Berry, Daniel J.
中科院分区：
文献类型：
--
作者：
Bozic, Kevin J.;Ong, Kevin;Lau, Edmund;Kurtz, Steven M.;Vail, Thomas P.;Rubash, Harry E.;Berry, Daniel J.
为了解决与传统金属-聚乙烯（M-PE）全髋关节置换术（THA）相关的关节面磨损和骨质溶解的长期问题，引入了金属-金属（M-M）和陶瓷-陶瓷（C-C）关节面。这些轴承表面与独特的风险和收益以及更高的成本相关。然而，这三种关节面在老年人群中的相对风险尚不清楚。我们比较了使用金属-聚乙烯（M-PE）、金属-金属（M-M）和陶瓷-陶瓷（C-C）关节面进行初次THA的Medicare患者的并发症和THA翻修的短期风险。我们使用2005年至2007年100%医疗保险住院索赔文件，对年龄、性别和美国人口普查地区匹配的三个不同THA患者队列（M-PE、M-M和C-C）进行匹配队列分析。构建多变量考克斯比例风险模型，以比较队列中的并发症和翻修THA风险，调整医疗合并症、种族、社会经济状况和医院因素。在调整患者和医院因素后，与C-C关节面（分别为0.59%和0.32%）相比，M-M关节面的假体周围关节感染风险更高（风险比，3.03;置信区间，1.02-9.09）。在翻修THA或任何其他并发症的调整风险方面，关节面队列之间没有其他差异。在适当匹配的Medicare THA患者中，无论关节面如何，短期并发症（包括脱位）和翻修THA的风险相似。硬对硬THA关节面在医疗保险患者中的价值值得怀疑，因为其使用成本较高，且老年患者的长期受益不确定。II级，预后研究。有关证据等级的完整描述，请参见作者指南。
To address the long-term problems of bearing surface wear and osteolysis associated with conventional metal-polyethylene (M-PE) total hip arthroplasty (THA), metal-metal (M-M), and ceramic-ceramic (C-C) bearings have been introduced. These bearing surfaces are associated with unique risks and benefits and higher costs. However the relative risks of these three bearings in an older population is unknown. We compared the short-term risk of complication and revision THA among Medicare patients having a primary THA with metal-polyethylene (M-PE), metal-metal (M-M), and ceramic-ceramic (C-C) bearings. We used the 2005 to 2007 100% Medicare inpatient claim files to perform a matched cohort analysis in three separate cohorts of THA patients (M-PE, M-M, and C-C) who were matched by age, gender, and US census region. Multivariate Cox proportional-hazards models were constructed to compare complication and revision THA risk among cohorts, adjusting for medical comorbidities, race, socioeconomic status, and hospital factors. After adjusting for patient and hospital factors, M-M bearings were associated with a higher risk of periprosthetic joint infection (hazard ratio, 3.03; confidence interval, 1.02–9.09) when compared with C-C bearings (0.59% versus 0.32%, respectively). There were no other differences among bearing cohorts in the adjusted risk of revision THA or any other complication. The risk of short-term complication (including dislocation) and revision THA were similar among appropriately matched Medicare THA patients regardless of bearing surface. Hard-on-hard THA bearings are of questionable value in Medicare patients, given the higher cost associated with their use and uncertain long-term benefits in older patients. Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.
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影响因子：
7.2
作者：
DEYO, RA;CHERKIN, DC;CIOL, MA
通讯作者：
CIOL, MA
影响因子：
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影响因子：
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影响因子：
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影响因子：
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