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Abstract Number: 199

Increasing Complexity of Patients Undergoing Primary Total Hip Arthroplasty in the U.S

Jasvinder A. Singh1 and David Lewallen2, 1University of Alabama and VA Medical Center, Birmingham, AL, 2Orthopedics, Mayo Clinic college of medicine, Rochester, MN

Meeting: 2014 ACR/ARHP Annual Meeting

Keywords: arthroplasty and outcomes, Hip

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Session Information

Title: Orthopedics, Low Back Pain and Rehabilitation

Session Type: Abstract Submissions (ACR)

Background/Purpose: To examine the time-trends in key demographic and clinical characteristics of patients undergoing primary total hip arthroplasty (THA).

Methods: We used the data from the Mayo Clinic Total Joint Registry from 1993-2005 to examine the time-trends in demographics (age, body mass index (BMI)), medical (Deyo-Charlson index) and psychological comorbidity (anxiety, depression) and underlying diagnosis of patients undergoing primary THA.  Chi-square test and analysis for variance were used.  Multivariable-adjusted logistic regression (age, sex, comorbidity-adjusted) compared 1993-95 to other study periods.  Odds ratio (OR) and 95% confidence interval (CI) are presented.

Results: The primary THA cohort consisted of 6,168 patients with 52% women.  Compared to 1993-95, significantly more patients (by >2-times for most) in 2002-05 had: BMI³40, 2.3% vs. 6.3%; depression, 4.1% vs. 9.8%; and anxiety, 3.4% vs. 5.7%; and significantly fewer had an underlying diagnosis of rheumatoid/inflammatory arthritis, 4.2% vs. 1.5% (p²0.01 for all).  In multivariable-adjusted models, compared to 1993-95, significantly more patients in 2003-05 had (all p-values²0.01): BMI³40, OR, 2.79 (95% CI: 1.85, 4.22); Deyo-Charlson Index³3, 1.32 (1.07, 1.63); depression, 2.25 (1.66, 3.05); and anxiety, 1.71 (1.19, 2.15).  Respectively, fewer patients had a diagnosis of RA/inflammatory arthritis: 0.28 (0.17, 0.46; p<0.01).  Over the 13-year study period, Deyo-Charlson index increased by 22% (0.9 to 1.1) and the mean age decreased by 0.7 years (65.0 to 64.3) (p<0.01 for both). 

Conclusion: Obesity, medical/psychological comorbidity and underlying diagnosis changed rapidly in primary THA patients over 13-years.  Studies of THA outcomes and utilization should take these rapidly changing patient characteristics into account.


Disclosure:

J. A. Singh,

takeda, savient,

2,

takeda, savient, regeneron, allergan,

5;

D. Lewallen,

Zimmer, Orthosonic and Osteotech,

8,

Pipeline Biomedical ,

5,

DePuy, Stryker, Biomet and Zimmer.,

2.

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