JOA - 2026-04-10 - Journal Article
Increasing Procedural Volume and Economic Impact of Revision Total Hip Arthroplasty for Hip Instability in the United States.
Heo KY, Lee JD, Brito M, Pisharody V, Naeini ZV, Wilson JM, Premkumar A
Topics
Key Takeaway
Revision THA for instability increased from 9,870 to 16,228 cases annually in the U.S. from 2012 to 2022, with projected volume of 28,830 cases and cumulative hospital charges of $533 million by 2035.
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Summary
This study queried two national U.S. databases to characterize inpatient and outpatient revision THA volume and costs attributable to instability from 2012 to 2022, excluding PJI cases. Annual case volume grew 64% from 9,870 to 16,228 over the decade, with average per-patient costs rising from $12,540 to $18,334. Linear and Poisson regression models project 28,830 annual cases and $533 million in cumulative hospital charges by 2035.
Key Limitation
Administrative database coding cannot distinguish primary instability etiology (component malposition, soft-tissue insufficiency, patient factors) from revision cases coded incidentally under instability, limiting mechanistic interpretation and potentially inflating or deflating true incidence.
Original Abstract
BACKGROUND
Instability remains one of the most common complications after total hip arthroplasty (THA) and is a notable cause of patient morbidity, pain, and dissatisfaction. Despite advances in implant technology and surgical techniques, the national incidence of instability after THA remains poorly defined. As THA continues to rise, our study aimed to characterize the contemporary volume and economic impact of revision THA (rTHA) for instability in the United States (U.S.).
METHODS
There were two national databases that were queried to identify inpatient and outpatient rTHA cases for instability between 2012 and 2022. Exclusion criteria included patients who presented with a periprosthetic joint infection. The national volume of rTHA for instability was calculated, and projected volumes of rTHA for instability were modeled using linear and Poisson regression to 2035.
RESULTS
In 2012, there were a total of 9,870 cases of rTHA for instability in the U.S., which increased to a total of 16,228 in 2022. By 2035, it is projected that there will be 28,830 cases of rTHA for instability. The average patient costs of rTHA for instability increased from $12,540 to $18,334 from 2012 to 2022. By 2035, patient costs are projected to reach an average of $25,612. The annual cumulative hospital charges increased from $138 million in 2012 to $294 million in 2022. Based on this rate, cumulative hospital charges are expected to increase to $533 million by 2035.
CONCLUSION
Our study demonstrated that the national volume and economic impact of rTHA for instability continue to rise, with a projected volume approaching 30,000 cases by 2035. Surgeons should be aware of these growing trends, as they emphasize the need for cost-effective care strategies and optimized surgical techniques to mitigate further risks of instability.