In a recent article published in the American Journal of Bone and Joint Surgery in October 2012, Dr. Jeff Katz and colleagues from Boston, Massachusetts, reviewed Medicare data on patients undergoing primary total hip replacement. Using Medicare claims data they were able to identify 51,347 patients who met eligibility criteria for the study. These patients had their primary hip replacement between July 1995 and June 1996 and then were followed for 12 years. They found the risk of dying during that 12 year followup period far exceeded the risk of revision, particularly for the cohort of patients over 75 years old at the time of their primary hip replacement. They noted that the risk of revision was highest during the first 18 months of the surgery typically reflecting early technical complications. They noted influence of surgeon volume on the risk of revision during the first 18 months postoperatively suggesting that surgeon experience influence the risk of technical failure but not risk of failure over the long-term. They found that patients of surgeons who performed fewer than 6 hip replacements a year had a higher risk of revision than those who performed more than 12 total hips per year. They noted a 1% per year risk of revision over the ensuing 10+ years after patient’s emerged from the initial 18 month followup period. This underscores the importance of getting the implant position correct and restoring length and offset to maximize function.
—William P. Barrett, MD