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Interview of Kevin J. Bozic, MD, MBA by Douglas W. Jackson,
MD
According to the
Nationwide Inpatient Sample (NIS) database, which is a stratified,
statistically valid survey of inpatient hospital visits in the United States,
there are almost 40,000 revision total hip arthroplasties (THAs) performed
annually in the United States. This number has steadily increased over the past
20 years, and is expected to continue to increase over the next several decades.
This increase is primarily due to an increased incidence of primary THA
procedures, an expansion of the indications for THA to include younger, more
active patients, and limitations in implant longevity...
...Between October 2005 and December 2006, the most common
causes of revision THA in the United States (see chart) were hip
instability (22.5%), mechanical loosening (19.7%) and infection
(14.8%). This represents a change from previous studies which
have implicated aseptic loosening, bearing surface wear and
osteolysis as the primary indications for revision THA. These
findings suggest that although implant factors play an important
role in THA failure, there are also patient factors, eg, age,
obesity, malnutrition, and other medical co-morbidities, and
surgeon factors, eg, experience, years in practice, surgical
technique, procedure volumes, and hospital affiliation, which
clearly influence THA outcomes and revision rates.
For more information:
Kevin J. Bozic, MD, MBA, is associate professor and vice
chair of the Department of Orthopaedic Surgery at the University
of California, San Francisco and Core Faculty, Philip R. Lee
Institute for Health Policy Studies. He can be reached at 500
Parnassus Ave. MU-320W, San Francisco, CA 94143
