Rates & Predictors of Failures of Total Hip Replacement:Population Based Study

在美国，髋关节的骨性关节炎影响着400多万人，导致20多万人 每年选择性全髋关节置换术(THR)。假体的失败是昂贵的和使人丧失能力的，导致 在美国，每年有3.7万例髋关节翻修术。尽管越来越多的证据表明 未来十年翻修全髋关节置换术的负担-伴随着并发症、残疾和 成本-美国基于人口的THR失败率尚未确定。此外，没有美国 THR失败危险因素的基于人群的研究。所有数据都已从转诊中心上报， 在那里表演一小部分Thr‘s。这些观察结果突显了以人口为基础的迫切需要 研究导致THR修订的失败率，并确定风险因素，特别是那些 可修改的。这项建议是建立在研究小组在人口方面的丰富经验基础上的。 关于苏氨酸在美国医疗保险人群中的使用和结局的研究。在以前的工作中，我们 收集了58,000名医疗保险受益人的基于索赔的队列，这些受益人在7月 1995年和1996年6月。在本申请中，我们建议跟踪该队列12年，跟踪该指数 THR将承担以下具体目标： 1)进行嵌套病例对照研究，以确定与假体相关的因素 故障导致在可选的主要THR之后进行修订。风险因素将从以下方面确定 医疗记录、医疗保险索赔、人口普查数据和美国医院协会数据。 2)估计导致翻修手术失败的累积发生率超过12 在以全国人口为基础的医疗保险受益者队列中持续数年，并确定因素 在国家索赔队列中与假体失败有关。 这些发现将提供全国对THR失败风险的估计和对各种因素的评估 与国家层面的THR故障有关。我们调查患者、外科医生和 医院层面，允许推断将在几个层面上指导临床和政策干预。这些 数据将允许临床医生更好地告知患者他们的种植体的预期寿命和有关 可能影响假体存活的因素，从而影响患者的生活质量。 总结：全髋关节置换术常用于严重的髋关节关节炎。几乎没有什么 国家一级可获得的信息，关于植入物正常工作多久，直到引起疼痛和 需要更换。这项研究使用医疗保险索赔和医疗记录中的信息来确定 髋关节置换失败的风险以及预测哪些患者将经历失败的因素。

Osteoarthritis of the hip affects over four million persons in the US and results in over 200,000 primary elective total hip replacements (THR) per year. Failure of the prosthesis is costly and disabling, resulting in 37,000 revision hip replacements annually in the US. Although increasing evidence points to a growing burden of revision total hip replacements over the next decade - with attendant complications, disability and costs - US population based rates of THR failure have not been determined. Further, there are no US population based studies of risk factors for THR failure. All data have been reported from referral centers, where a minority of THR's is performed. These observations highlight the urgent need for population-based studies of the rate of failure leading to revision THR and to identify risk factors, especially those that are modifiable. This proposal builds upon the extensive experience of the research team in population-based studies of the utilization and outcomes of THR in the US Medicare population. In previous work we assembled a claims-based cohort of 58,000 Medicare beneficiaries who had elective THR between July 1995 and June 1996. In this application we propose to follow this cohort for twelve years following the index THR to undertake the following specific aims: 1) To perform a nested case control study in order to identify factors associated with prosthesis failure leading to revision following elective primary THR. Risk factors will be ascertained from medical records, Medicare claims, Census data and American Hospital Association data. 2) To estimate the cumulative incidence rate of prosthesis failure leading to revision THR over twelve years in a national population-based cohort of Medicare beneficiaries, and to identify factors associated with prosthesis failure in the national claims cohort. The findings will provide a national estimate of the risk of THR failure and an assessment of factors associated with THR failure at a national level. We investigate risk factors at the patient, surgeon and hospital level, permitting inferences that will guide clinical and policy interventions at several levels. These data will permit clinicians to better inform patients about the anticipated longevity of their implants and about factors that may influence prosthesis survival, and consequently the patient's quality of life. Lay Summary: Total hip replacement is done frequently for severe arthritis of the hip. There is very little information available at a national level on how long the implants work properly until they cause pain and need to be replaced. This study uses information from Medicare claims and medical records to determine the risk of failure of the hip replacement and the factors that predict which patients will experience a failure.