Depression Greatest Risk Factor for Early THA Revision in Elderly Patients

Maureen Leahy

Elderly total hip arthroplasty (THA) patients with certain comorbidities are at increased risk of early revision, according to data presented in poster P072 “Risk Factors for Early Revision Following Primary Total Hip Arthroscopy in Medicare Patients,” on display in Academy Hall B, McCormick Place.

Patient, surgeon, health system, and device factors are all known to influence outcomes in THA, according to the authors. However, patient-related risk factors for early THA failure are poorly understood, particularly in older patients. The purpose of the study was to identify specific demographic and clinical characteristics associated with an increased risk of early revision in Medicare THA patients.

Using data from the National Medicare 5 percent sample covering the period 1998–2010, the researchers calculated the relative risk of revision within 12 months of primary THA as a function of baseline medical comorbidities in 56,030 patients. They used a Cox Regression Model to examine the impact of 29 comorbid conditions (Table 1) on the risk of early revision, controlling for age, sex, race, census region, socioeconomic status, and all other baseline comorbidities. All comorbidities were defined by administrative claims data, as reported in the Medicare 5 percent sample. Adjusted hazard ratios (HR) were constructed for each condition, and Wald’s X2 statistic was used to rank the degree of association of comorbidities with the risk of early revision.

The researchers found that the most significant comorbidities associated with early revision (in order of significance, P <0.040, for all comparisons) were the following:

depression (HR = 1.64)
rheumatologic disease (HR = 1.32)
psychoses (HR = 1.34)
renal disease (HR = 1.29)
urinary tract infection (HR = 1.15)
congestive heart failure (HR = 1.20)

The authors noted that this information is important when counseling elderly THA patients regarding the risk of early failure and for risk-stratifying publicly reported outcomes in Medicare THA patients.

To view this poster as an iPoster, visit http://aaos.posterview.com

The authors of “Risk Factors for Early Revision Following Primary THA in Medicare Patients,” are Kevin J. Bozic, MD, MBA; Edmund Lau, MS; Kevin L. Ong, PhD; Vanessa Chan, MPH; Steven M. Kurtz, PhD; Thomas P. Vail, MD; Harry E. Rubash, MD; and Daniel J. Berry, MD.

Disclosures: Dr. Bozic—AAOS; American Association of Hip and Knee Surgeons (AAHKS); American Joint Replacement Registry; American Orthopaedic Association; California Joint Replacement Registry Project; California Orthopaedic Association; Harvard Business School; Orthopaedic Research and Education Foundation. Mr. Lau—Stryker; Kyphon Inc.; Amgen Co; Alcon Corp. Dr. Ong—Stryker; Medtronic; Biomet; Journal of Arthroplasty. Dr. Kurtz—Stryker; Zimmer; Biomet; DePuy; Medtronic; Invibio; Stelkast; Ticona; Formae; Kyocera Medical; Wright Medical Technology; Ceramtec; DJO; Journal of Arthroplasty; AAOS Exhibits Committee. Dr. Vail—DePuy, A Johnson & Johnson Company; Journal of Arthroplasty; American Board of Orthopaedic Surgery, Inc.; AAHKS; Knee Society. Dr. Rubash—Pipeline; Biomet; Zimmer; Wolters Kluwer Health–Lippincott Williams & Wilkins; Hip Society. Dr. Berry—DePuy, A Johnson & Johnson Company. Ms. Chan—no disclosures.

2013 Annual Meeting News
Tuesday through Friday, February 19 – 23, 2013.
http://www.aaos.org/news/acadnews/2013/AAOS29_3_19.asp