When the Birmingham Hip Resurfacing (BHR) metal-on-metal implant system was approved by the United States Food and Drug Administration in 2006, a multicenter, prospective, post-approval study (PAS) was required. This study uses data from the PAS to investigate metal level and glomerular filtration rate (GFR) trends over the first decade in vivo. Between October 2006 and March 2011, 290 primary BHR procedures were performed among 262 patients at 5 sites. Whole blood samples were sent to a single specialized laboratory to determine GFR, cobalt (Co) and chromium (Cr) levels. The population for this study consists of 117 unrevised unilateral patients with a mean age at surgery of 51.3±6.5 years who had pre-operative, 1-year, 4-year, 5-year and 10-year laboratory data. The mean follow-up for these patients that included 36 females was 10.1±0.2 years. Median metal levels at 1-year increased relative to pre-operative values for Co (by a factor of 9.7 from 0.13 to 1.26 ppb, p<0.001) and Cr (by a factor of 2.5 from 0. 60 to 1.50 ppb, p<0.001). Metal levels subsequently remained relatively constant over time with a median 10-year value of 1.12 ppb for Co and 1.29 ppb for Cr. Based on 585 blood samples from all 117 patients, there was no relationship between GFR and Co (→=−0.06, p=0.14) or Cr (→=0.05, p=0.27) levels. However, lower pre-operative GFR values were associated with larger increases in Co at 1-year relative to the pre-operative level (→=−0.26, p=0.005). There was no relationship between pre-operative GFR values and changes in Cr at 1 year (→=−0.13, p=0.15). Through the first decade in vivo, elevated whole blood metal levels for unilateral BHR patients do not appear to adversely affect GFR. However, patients with lower pre-operative GFR values tend to have larger increases in their Co level at 1-year.
The BIRMINGHAM HIP◊ Resurfacing is a metal-on-metal (MOM) hip implant system approved by the US FDA in 2006. The approval required a multicenter, prospective, post-approval study (PAS). Our purpose is to report the current minimum 10-year results. 253 patients (280 hips) had surgery between October 2006 and December 2009 at one of 5 sites. We report revisions, survivorship, EQ-5D, Harris Hip Score (HHS), radiographic findings, and metal levels including cobalt (Co) and chromium (Cr). The mean age at surgery was 51 years, 74% male, BMI 28, osteoarthritis 95%. 243 (87%) of hips have known outcome or 10-year minimum follow-up (fup). Prior to 10 years, 5 patients died, 20 hips were revised, and 37 hips did not complete 10-year fup.Introduction
Methods
The rise of the anterior approach (AA) in primary surgery has led to enthusiasm for using this approach in revision surgery, especially because head and liner exchanges have been accompanied by a high dislocation rate when the posterior approach (PA) is used. The aim of this study was to compare the institutional dislocation rate comparing the PA and AA in isolated head and liner exchange. A retrospective institutional database query was done to identify all aseptic head and liner exchanges between the years 2010- June, 2020. 186 hips were identified with an average age of 64.8+/−10.8 yrs (27.9–87.6) and average BMI of 28.7+/−6.3 kg/m2 (16.2–52). The reason for revision was polyethylene wear and osteolysis in 105 hips (56.5%), adverse tissue reaction to metal on metal (MOM) in 43 hips (23.1%), and recurrent instability in 38 hips (20.4%). The approach used for the revision surgery was PA in 128 hips (68.8%) and AA in 58 hips (31.2%). The mean follow-up for this cohort is 1.9±2 yrs (0.0–8.6).Introduction
Methods
Prior to the introduction of alternative bearing surfaces, patients were typically counseled to expect that their total hip arthroplasty (THA) using conventional polyethylene would last for 10 years. With the introduction of crosslinked polyethylene and hard-on-hard bearing surfaces, revisions related to bearing surface wear were expected to decrease. We examined six different bearing surfaces used at our institution over three decades to evaluate how the overall survivorship, reasons for revision and Harris Hip Scores have changed with time. We identified six cohorts of patients with 754 primary hips done between 1983 and 2007. With the exception of 81 Birmingham hip resurfacings (BHR), all femoral components were straight, extensively porous-coated cylindrical (EPC) stems (AML and Prodigy). All cups were porous coated. In addition to the BHRs, the bearing surfaces included 223 conventional polyethylene (CPE) in a non-modular shell, 114 CPE in a modular shell, 116 crosslinked polyethylene (XLPE), 130 metal-on-metal (MOM), and 90 ceramic-on-ceramic (COC). The mean follow-up for all hip replacements is 13.0±6.0 years. Kaplan-Meier survivorship using revision for any reason as an endpoint with log rank testing was used to evaluate differences among groups.Introduction
Methods
The statements contained in this document are solely those of the authors and do not necessarily reflect the views or policies of CMS. The authors assume responsibility for the accuracy and completeness of the information contained in this document. The Bundled Payments for Care Improvement (BPCI) initiative was introduced to reduce healthcare costs while maintaining quality. We examined data from a healthcare system comprised of five hospitals that elected to participate in the BPCI Major Joint Replacement of the Lower Extremity Model 2 initiative beginning July 1, 2015. We compared one hospital that did 439 BPCI hip cases to the four other hospitals that did 459 cases. Stratifying the data by hospital volume, we sought to determine if costs decreased during the BPCI period, how the savings were achieved, and if savings resulted in financial rewards for participation. The Medicare data included the target cost for each episode (based on historical data from 2009–2012 for each hospital that was adjusted quarterly) and actual Part A and Part B spending for 90 days. Using 1,574 primary hip replacements, we analyzed the costs associated with the anchor hospitalization, inpatient rehabilitation, skilled nursing facilities, home health, outpatient physical therapy and readmission to compare the 898 hips done during the 16-month BPCI initiative period with the 676 hips done during the 1-year period preceding BPCI participation. Owing to the nonparametric distribution of the cost data, a Mann-Whitney U test was used to compare the higher volume hospital with the four lower volume hospitals.Background
Methods
The statements contained in this document are solely those of the authors and do not necessarily reflect the views or policies of CMS. The authors assume responsibility for the accuracy and completeness of the information contained in this document. The Bundled Payments for Care Improvement (BPCI) initiative was introduced to reduce healthcare costs while maintaining quality. We examined data from a healthcare system comprised of five hospitals that elected to participate in the BPCI Major Joint Replacement of the Lower Extremity Model 2 initiative beginning July 1, 2015. We compared one hospital that did 507 BPCI knee cases to the four other hospitals that did 566 cases. Stratifying the data by hospital volume, we sought to determine if costs decreased during the BPCI period, how the savings were achieved, and if savings resulted in financial rewards for participation. The Medicare data included the target cost for each episode (based on historical data from 2009–2012 for each hospital that was adjusted quarterly) and actual Part A and Part B spending for 90 days. Using 1,836 primary knee replacements, we analyzed the costs associated with the anchor hospitalization, inpatient rehabilitation, skilled nursing facilities, home health, outpatient physical therapy and readmission to compare the 1,073 knees done during the 16-month BPCI initiative period with the 763 knees done during the 1-year period preceding BPCI participation. Owing to the nonparametric distribution of the cost data, a Mann-Whitney U test was used to compare the higher volume hospital with the four lower volume hospitals.Background
Methods
