Are trends in THA bearing surface continuing to change? 2007-2015 usage in a large database cohort
- Bedard N.A., Burnett R.A., DeMik D.E., Gao Y, Liu S.S., Callaghan J.J.
- J Arthroplasty. 2017 Dec;32(12):3777-3781. doi: 10.1016/j.arth.2017.07.044. Epub 2017 Aug 3.
- Level of Evidence:
- Not indicated
The authors reviewed the Humana Inc. administrative claims data-set from years 2007 to third quarter of 2015 to analyse the bearing surface usage in primary THA as function of age (< 65 Vs. ≥ 65 years), gender and Humana insurance type (privately insured Vs. Medicare/Medicaid Advantage plans through Humana).
The primary THA patients were identified utilizing the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM). The cutoff at third quarter of 2015 was chosen due to transition to ICD-10 coding system.
The multivariate logistic regression analysis was performed to identify the impact of age, gender and insurance type on a cohort of patients with either MoP and CoP.
28,504 out of 67,010 primary THAs recorded in the Humana data-set had the ICD-9-CM identifier for the bearing surface type. 24,018 out of 58,439 (41,1 %) of patients insured with Humana as part of their Medicare/ Medicaid Advantage plans and 4,072 out of 8,571 (47.5 %) privately insured had the ICD-9-CM identifier for the bearing surface type. 58.7 % of 28,504 were female.
Metal-on-polyethylene (MoP) showed the highest usage (46.1 %), followed by ceramic-on-polyethylene (CoP; 33.2 %), metal-on-metal (MoM; 17.1 %) and ceramic-on-ceramic (CoC; 3.6 %). CoP increased from from 6.4 % in 2007 to 52.0 % in 2015. In the same period MoM decreased from 39.2 % to 5.4 %. The decrease in use of CoC was subtle (i.e. from 7.1 to 3.2 %). The usage of MoP decreased from 53.6 % in 2012 to 39.8 % in 2015.
65 years patients and older were more likely to receive MoP, as well as privately insured patients. Gender resulted to be not a predictor of bearing surface type.
Patient age factor resulted to be a predictor of bearing choice. In light of adverse reactions to metal debris, the risk of the use of metal heads in older patients should be reviewed.
- Data dependent upon the administrative claims data-base documentation and coding.
- Over half of the THAs had not bearing surface related ICD-9-CM codes.
- Relatively small number of THAs, when compared to that performed in US annually.
- Bearing choices in primary THAs have tremendously changed from 2007 to 2015.
- Patient age is a significant factor in bearing choice.
- Considering the growing concern of fretting corrosion issues, age might be not a factor in bearing choice.