Costs and Outcomes after Primary and Revision Hip Replacements by Implant Bearing Materials: Analysis of 550,760 linked Patient Records from English Routinely Collected Databases.

Abstract

Objective: We investigated 10-year revision risks, hospital admission costs, and quality-of-life for patients in the year after elective primary and revision total hip replacement (THR), overall and by implant bearing materials and fixation combination.

Methods: We analysed linked National Joint Registry, Hospital Episode Statistics, and Patient Reported Outcome Measures databases for adults undergoing elective primary THR in England (2009-2018). Implants were classified by bearing material combinations (cobalt-chrome and stainless-steel [CC/SS], delta or alumina ceramics, and highly or non-highly crosslinked polyethylene [HCLPE]) and fixation (cemented, uncemented, and hybrid). We estimated hazard ratios with flexible parametric survival models, and generalised linear models for costs and quality-of-life. Missing quality-of-life data was imputed using multiple imputation.

Results: We analysed 550,760 elective primary (mean age=69, SD=10.7) and 9,590 subsequent revisions THRs. On average, a primary THR costed, £10,365 (95% confidence interval £10,350,£10,381); quality-of-life after primary was 0.786 (0.785,0.786), and 10-year revision risk was 2.4% (2.08%,2.78%). First and second revisions costed, on average, £20,387 and £24,290; with mean quality-of-life scores of 0.609 and 0.502 , respectively. Compared with cemented CC/SS-on-HCLPE, cemented delta-on-HCLPE, uncemented delta-on-HCLPE, and hybrid delta-on-HCLPE, alumina-on-HCLPE, delta-on-delta and alumina-on-alumina were associated with lower one-year costs, improved quality-of-life, and lower 10-year revision risks.

Conclusions: Revision surgery costs double that of an elective primary with drastically lower quality-of-life. Bearing materials and fixation were associated with varying one-year costs, quality-of-life scores and revision risks. Although observational data may be affected by unmeasured confounding, our findings could help guide procurement decisions given changing trends in implant choice.