JAMA Internal Medicine: Orthopedic Surgery Topic Collection

What Does a Hip Replacement Cost? The Transparency Imperative in 2013 Comment on “Obtaining Consumer Prices From US Hospitals for a Common Surgical Procedure” What Does a Hip Replacement Cost?

Steinmetz A, Emanuel EJ. — Mon, 25 Mar 2013 00:00:00 GMT

In the 1950s, the American automobile industry was rife with information asymmetries, leaving prospective buyers at the mercy of the dealer. Rarely would a buyer know the full price of a new car until after he or she had committed to buying it. Rarer still would that buyer know anything about the quality of the vehicle he or she had decided to purchase. And while every new Ford and Chevy came with a manufacturer's suggested retail price (MSRP), and various quality and safety metrics, none of that information was required to be disclosed prior to a sale. Exorbitant shipping charges and phony “preparation fees” were frequently tacked on without the buyer's knowledge. Price disparities from dealer to dealer were exceedingly vast. The result in the mid-20th century was a broken automobile industry that stuck American families with unnecessarily high bills.

Hip Implant Failure for Men and Women What and When We Need to Know Comment on “Sex and Risk of Hip Implant Failure” Hip Implant Failure for Men and Women

Zuckerman D. — Mon, 25 Mar 2013 00:00:00 GMT

Total hip arthroplasty (THA) is a popular procedure that is increasing as the baby boom generation ages. In this issue of the journal, Inacio et al report that most US patients undergoing THA are women, who have a 29% higher risk of short-term THA failure than men after statistically controlling for key risk factors.

Sex and Risk of Hip Implant Failure Assessing Total Hip Arthroplasty Outcomes in the United States Hip Implant Failure

Inacio MS, Ake CF, Paxton EW, et al. — Mon, 25 Mar 2013 00:00:00 GMT

Importance

The role of sex in relationship to implant failure after total hip arthroplasty (THA) is important for patient management and device innovation.

Objective

To evaluate the association of sex with short-term risk of THA revision after adjusting for patient, implant, surgery, surgeon, and hospital confounders.

Design and Setting

A prospective cohort of patients enrolled in a total joint replacement registry from April 1, 2001, through December 31, 2010.

Participants

Patients undergoing primary, elective, unilateral THA.

Main Outcome Measures

Failure of THA, defined as revision procedure for (1) any reason, (2) septic reason, or (3) aseptic reason after the index procedure.

Results

A total of 35 140 THAs with 3.0 years of median follow-up were identified. Women constituted 57.5% of the study sample, and the mean (SD) patient age was 65.7 (11.6) years. A higher proportion of women received 28-mm femoral heads (28.2% vs 13.1%) and had metal on highly cross-linked polyethylene-bearing surfaces (60.6% vs 53.7%) than men. Men had a higher proportion of 36-mm or larger heads (55.4% vs 32.8%) and metal on metal-bearing surfaces (19.4% vs 9.6%). At 5-year follow-up, implant survival was 97.4% (95% CI, 97.2%-97.6%). Device survival for men (97.7%; 95% CI, 97.4%-98.0%) vs women (97.1%; 95% CI, 96.8%-97.4%) was significantly different (P = .01). After adjustments, the hazards ratios for women were 1.29 (95% CI, 1.11-1.51) for all-cause revision, 1.32 (95% CI, 1.10-1.58) for aseptic revision, and 1.17 (95% CI, 0.81-1.68) for septic revision.

Conclusions

After considering patient-, surgery-, surgeon-, volume-, and implant-specific risk factors, women had a 29% higher risk of implant failure than men after THA in this community-based sample.

In This Issue of JAMA Internal Medicine

Mon, 25 Mar 2013 00:00:00 GMT