Dislocation remains a serious issue following Total Hip Arthroplasty (known as hip replacement). Its prevalence is documented in the literature and several joint registries highlight it is a common cause of revision surgery to repair an artificial hip joint. Although publications exist examining the costs associated with dislocation, it is an area that is not fully understood and an opportunity exists to gain increased awareness of the healthcare resource utilisation associated with this complication in England. The main focus is on the headline cost of a revision procedure, but the decision to revise will only be made once several attempts at conservative treatment (closed reduction or open reduction) have been undertaken. Each of these treatment cycles carry cost and quality of life consequences. Once successful treatment is completed the patient will require additional rehabilitation and may be at a higher risk of further complications.
This research therefore aims primarily to quantify the costs associated with hip dislocation over two years following primary surgery; examining conservative and surgical treatment, as well as other associated costs, health care resource utilisation and quality of life.
Additionally, given the close functional connection between the hip and the spine, their simultaneous degenerative pathology is a common problem seen in orthopaedic patients. Reports have shown that patients undergoing spinal surgery and subsequent total hip arthroplasty have higher risks of dislocation. This research aims to also understand if spine surgery prior to or after hip replacement has an impact on post hip replacement dislocation rates in England.
The objective of this retrospective longitudinal cohort study is primarily designed to determine mid-term (two-year) costs, healthcare resource utilization (HRU, including hospital length of stay, length of ICU stay and costs, number of outpatient hospital visits and costs, number of community care resources utilization and costs), dislocation data (including number of dislocation and number of reduction procedures or revision surgeries for dislocation), and quality of life (QoL) among patients with dislocation versus those without following primary total hip arthroplasty. Patients with a primary total hip arthroplasty between 2010 and 2015 will be selected. The main exposure variable will be presence of dislocation within one year following the primary total hip arthroplasty. Patients with dislocation will be matched to patients without dislocation according to their propensity scores. Analyses will be both descriptive and comparative. Multivariable models will be used to adjust for residual confounding and appropriate generalized linear models (GLMs) will be chosen based on the outcome variable of interest for HRU, costs and QoL.
Secondarily as an exploratory analysis, the impact of lumbar spine surgery (12 months before PTHA or 12 months after PTHA) on the incidence of dislocation following PTHA will be evaluated. First, incidences of dislocation after PTHA will be calculated comparing patients with spinal surgery pre-PTHA to patient without spinal surgery pre-PTHA. Additionally, incidences of dislocation post-PTHA and post spinal surgery will be evaluated for patient with spinal surgery post-PTHA compared to patient without spinal surgery post-PTHA. Patients with spinal surgery will be matched to patients without spinal surgery according to their propensity scores. Analyses will be both descriptive and comparative. Multivariable logistic regression models will be used to adjust for residual confounding on the outcome variable of interest.
Total cost at 2 years post-primary; Healthcare resource utilisation at 2 years post-primary; Mortality at 2 years post-primary; quality of life change due to dislocation (+/- revision).
Thibaut Galvain - Chief Investigator - Johnson & Johnson Medical SAS
Thibaut Galvain - Corresponding Applicant - Johnson & Johnson Medical SAS
Abhishek Chitnis - Collaborator - Johnson & Johnson ( JnJ - USA )
Alexander Mensch - Collaborator - Johnson & Johnson ( JnJ - USA )
Cindy Tong - Collaborator - Johnson & Johnson ( JnJ - USA )
David Fawley - Collaborator - Johnson & Johnson ( JnJ - USA )
Jack Mantel - Collaborator - Johnson & Johnson ( JnJ - USA )
Jessica Behrle - Collaborator - Johnson & Johnson ( JnJ - USA )
Joshua Bridgens - Collaborator - Johnson & Johnson ( JnJ - USA )
Tim Board - Collaborator - University of Manchester
HES Accident and Emergency;HES Admitted Patient Care;HES Outpatient;HES PROMS (Patient Reported Outcomes Measure);ONS Death Registration Data