Fixation Method and Subsequent Revision Rates for Elective Primary Hip Arthroplasty in People Aged 70 Years and Older: Analysis of National Administrative Data Sets by the UK Getting It Right First Time Program

Abstract

Background: We aimed to understand the role of fixation method in predicting subsequent revision rates in people aged 70 years and older undergoing elective primary total hip arthroplasty (THA) within the UK National Health Service (NHS).

Methods: Data on elective primary THAs conducted in people aged 70 years and older between April 1, 2012, and March 31, 2018, and subsequent revisions conducted up to March 31, 2019, were extracted from the Hospital Episodes Statistics database for all NHS procedures in England. A flexible parametric competing risks model was used to identify the role of fixation method in predicting revision and adjust for age, sex, frailty, year of surgery, and all-cause mortality.

Results: Data were available for 190,656 procedures. Crude revision rates at 1-7 years follow-up in those who had cemented, hybrid/reverse hybrid, and uncemented fixation were 1.8%, 1.8%, and 2.3%, respectively. There was a high level of variation between NHS trusts in the proportionate use of fixation method. The differences in the hazard of revision between uncemented and cemented fixation (hazard ratio, 1.238 [95% confidence interval, 1.148-1.336]) and hybrid/reverse hybrid fixation (hazard ratio, 1.184 [95% confidence interval, 1.082-1.297]) were both significant. In secondary analysis, there was evidence that revision rates in trusts where uncemented fixation predominated were not significantly lower for uncemented fixation compared to all other fixation methods.

Conclusions: Revision rates were significantly higher for elective primary THA in people aged 70 years and older who have uncemented fixation, compared to those who had cemented and hybrid/reverse hybrid fixation.

Keywords: arthroplasty; fixation method; orthopedics; revision; total hip arthroplasty.