Over the past 20 years, wondered a team of researchers, how often has total hip arthroplasty (THA) been performed in patients under 21, what are the epidemiologic characteristics of these individuals, and what are the characteristics of the facilities where these procedures were performed? Their study, “Use of Total Hip Arthroplasty in Patients Under 21 Years Old: A US Population Analysis,” appears in the August 9, 2021, edition of The Journal of Arthroplasty.
“Previously we had a lot of young inflammatory arthritis patients undergoing joint replacements,” said co-author Bella Y. Mehta, M.B.B.S., M.S., M.D. to OTW.
Dr. Mehta, a physician at Hospital for Special Surgery and Weill Cornell Medical College, both in New York, added, “Over the years, with better disease control and biologics, these cases have gone down. We wanted to know if this was the case nationally in patients < 21 years of age. Also, we wanted to know if more procedures are done in these patients.”
After reviewing an inpatient U.S. national weighted sample of hospital admissions in patients under 21 from (approx. 4,200 hospitals in 46 states), the team found that the number of THAs performed in this age group from the Kids’ Inpatient Database increased from 347 in 2000 to 551 in 2016, with the most frequent diagnoses being osteonecrosis, osteoarthritis, and inflammatory arthritis. Specifically, the frequency of THA for patients with osteonecrosis increased from 24% in 2000 to 38% in 2016; the frequency of THA for patients with inflammatory arthritis decreased from 27% in 2000 to 4% in 2016.
“During the study period, 80.3% of THAs were performed in urban teaching hospitals, 17.3% were performed in urban non-teaching hospitals, and 2.4% were performed in rural hospitals,” wrote the authors. “The percentage of THAs performed in urban teaching hospitals increased over the study period… Length of hospital stay in patients under 21 after undergoing THA decreased during the study period from a mean of 7.3 days in 2000 to 3.2 days in 2016.”
“Overall,” said Dr. Mehta to OTW, “the number of THAs are increasing even though the patients with inflammatory arthritis have a lower number of surgeries. Likely this is because joint damage even in young patients is recognized and instead of these patients being permanently disabled, we are able to observe and treat them with a THA.”
