Trends In Hip Resection Arthroplasty In The Medicare Patient Population From 2005 To 2012

Intro: Hip resection arthroplasty (HRA) is a relatively uncommon, yet viable surgical procedure developed by Girdlestone for osteomyelitis of the proximal femur. Currently, HRA is primarily indicated as a salvage procedure after a failed THA. Despite a continuous rise in the rates of hip arthroplasty, there is a lack of published evidence regarding the extent of HRA`s current use. We sought to provide an epidemiological description of the recent utilization patterns of HRA in the United States.

Methods: A level of evidence IV, retrospective case series review of the entire Medicare files between 2005 and 2012 was conducted using the current procedural terminology codes and International Classifiction of Disease ninth edition codes. Linear regressions and Chi-square tests were used for analysis. Subgroup analysis was performed by patient age.

Results: The total number of HRA`s performed between 2005 and 2012 significantly decreased from 4,248 to 3,872 (p=0.025). There was a significant increase in the annual incidence of HRA among patients < 65 years old (p=0.027, 9% increase) and 65 to 69 years old (p=0.007, 22% increase), constituting 43% of the total. There was a significant decrease in HRA incidence among patients 80 to 84 year old (p=0.001, 32% decrease) and > 85 years old (p=0.002, 24% decrease). Geographic analysis demonstrated the most HRA procedures were performed in the South, whereas gender analysis demonstrated a statistically significant decrease in HRA incidence for females (p=0.003, 6% decrease) and a significant increase in incidence for males (p=0.003, 7% increase).

Conclusion: The overall annual incidence of HRA performed in the Medicare patient population has significantly decreased in recent years. However, this conceals an increased incidence among the relatively younger patient population. Potential causes for these opposing trends include changes in rates of revision surgery, alternative indications for surgery, advances in hardware, and surgeon expertise.