No influence of immigrant background on the outcome of total hip arthroplasty. 140,299 patients born in Sweden and 11,539 immigrants in the Swedish Hip Arthroplasty Register.
OBJECTIVE
Total Hip Replacement (THA) is one of the most successful and cost-effective operations. Despite its benefits, marked ethnic differences in the utilization of THA are well documented. However, very little has been published on the influence of ethnicity on outcome. We investigate whether the outcome-in terms of reoperation within 2 years or revision up to 14 years after the primary operation-varies depending on ethnic background.


METHODS
Records of total hip arthroplasties performed between 1992 and 2007 were retrieved from the Swedish Hip Arthropalsty Registry and integrated with data on ethnicity of patients from 2 demographical databases (i.e. Patient Register and Statistics Sweden). The first operated side in patients with THA recorded in the Swedish Hip Arthroplasty Register (SHAR) between 1992 and 2007 were generally included. We excluded patients with 1 Swedish and 1 non-Swedish parent and patients born abroad with 2 Swedish parents. After these exclusions 151,838 patients were left for analysis. There were 11,539 Swedish patients born outside Sweden. We used a Cox regression model including age, sex, diagnosis, type of fixation, whether or not there was comorbidity according to Elixhauser or not, marital status and educational level.


RESULTS
The mean age was lowest in the group of patient coming from outside Europe including the former Soviet Union (61 years), and highest in the Swedish population (70 years). Before adjustment, for covariates, patients born in Europe outside the Nordic countries showed a lower risk to undergo early reoperation (HR = 0.73, 95% CI: 0.56-0.97), which increased after adjustment to (HR = 0.76, 95% CI: 0.58-1.01). Before adjustment, patients born in the Nordic countries outside Sweden and those born outside Europe (including the former Soviet Union) showed a higher risk to undergo revision than patients born in Sweden (HR = 1.14, 95% CI: 1.02-1.27; HR = 1.49, 95% CI: 1.2-1.9), but this difference disappeared after adjustment for covariates.


CONCLUSIONS
We did not find any certain differences in reoperation within 2 years, or revision within 14 years, between patients born in Sweden and immigrants. Further studies are needed to determine whether our observations are biased by the attitude of health providers regarding performance of these procedures, or by a reluctance of certain patient groups to seek medical attention should any complications requiring reoperation or revision occur.
Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden. ferid.krupic@vgregion.se
Ferid
F
Krupic
Thomas
T
Eisler
Tore
T
Eliasson
Göran
G
Garellick
Max
M
Gordon
Johan
J
Kärrholm
D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000706:statistics & numerical data*; D054242:Emigrants and Immigrants / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012042:Registries / Q000706:statistics & numerical data; D012086:Reoperation / Q000706:statistics & numerical data; D013548:Sweden / Q000453:epidemiology / Q000208:ethnology; D013997:Time Factors; D016896:Treatment Outcome