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

在美国，髋关节骨关节炎影响超过四百万人，并导致超过200，000例原发性髋关节炎。 选择性全髋关节置换术（THR）。假体的失败是昂贵的和致残的，导致 美国每年有37，000例髋关节翻修手术。尽管越来越多的证据表明 未来十年全髋关节置换翻修的负担-伴随并发症，残疾和 成本-基于美国人群的THR失败率尚未确定。此外，没有美国 基于人群的THR失败风险因素研究。所有数据均来自转诊中心， 进行少数THR的地方。这些意见突出表明，迫切需要以人口为基础的 研究导致翻修THR的失败率，并确定风险因素，特别是那些 可修改.这项建议是基于研究小组在人口基础研究方面的广泛经验。 THR在美国医疗保险人群中的使用和结局研究。在以前的工作中， 收集了一个基于索赔的队列，其中有58，000名医疗保险受益人，他们在2010年7月至2011年7月期间进行了选择性THR， 1995年和1996年6月。在本申请中，我们建议按照指数跟踪该队列12年 THR将实现以下具体目标： 1)进行巢式病例对照研究，以确定与假体相关的因素 失败导致择期初次THR后翻修。风险因素将从 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12年以上导致翻修THR的假体失效累积发生率 年在全国人口为基础的医疗保险受益人队列，并确定因素 与国家索赔队列中的假体失效相关。 研究结果将提供一个全国性的THR失败风险估计和因素评估 与THR失败相关的风险我们调查了患者、外科医生和 医院一级，允许推论，将指导临床和政策干预在几个层面。这些 数据将允许临床医生更好地告知患者植入物的预期寿命， 可能影响假体生存并因此影响患者生活质量的因素。 摘要：全髋关节置换术经常用于治疗严重的髋关节炎。很少有 国家一级关于植入物正常工作多久直到引起疼痛的信息， 需要更换。这项研究使用来自医疗保险索赔和医疗记录的信息来确定 髋关节置换术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.