title: National Trends in Primary Total Hip Arthroplasty in Extremely Young Patients: A Focus on Bearing Surface Usage From 2009 to 2012.
abstract: The ideal bearing surface for primary total hip arthroplasty (THA) in young patients remains a debate. Data on recent national trends are lacking. The purpose of this study is to provide an analysis on the national epidemiologic trends of bearing surface usage in patients aged ≤30 years undergoing THA from 2009 through 2012.
  
  
  
  Using the Healthcare Cost and Utilization Project Nationwide Inpatient Sample from 2009 to 2012, 9265 THA discharges (4210 coded by bearing surface) were identified in patients aged ≤30 years. Prevalence of surface type was analyzed along with patient and hospital demographic data. Statistical analysis was performed using SAS (SAS version 9.1; SAS, Inc, Cary, NC). Significance was set at P < .05.
  
  
  
  Ceramic-on-polyethylene (CoP) bearing surfaces were most commonly used, representing 35.6% of cases, followed by metal-on-polyethylene (MoP; 28.0%), metal-on-metal (MoM; 19.3%), and ceramic-on-ceramic (CoC; 17.0%) bearing surfaces. Hard-on-hard bearing surfaces (MoM and CoC) represented only 36.4% of cases, a significant decrease from previously reported findings (2006-2009) where hard-on-hard bearing surfaces were the majority (62.2%; P < .05). Hard-on-hard bearing surface usage decreased from 2009 to 2012 (MoM: 29.7% to 10.2%; CoC: 20.0% to 14.7%), whereas hard-on-soft bearing surface usage (MoP and CoP) increased. CoP bearing surfaces saw the most significant increase from 25.7% in 2009 to 48.2% in 2012. A cost analysis revealed that CoP discharges were associated with higher hospital charges than other surface types, with an average charge of $66,457 (P < .05).
  
  
  
  Use of hard-on-hard surfaces has decreased significantly in this population, whereas CoP and MoP surfaces have become increasingly common. Determining the optimal bearing surface for extremely young patients continues to be a challenge for orthopedic surgeons as they weigh the risks and benefits of each.
authors.affiliation: Department of Orthopaedics, Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: Sean S
authors.initials: SS
authors.lastname: Rajaee
authors.affiliation: Department of Orthopaedics, Tufts University School of Medicine, Boston, Massachusetts.
authors.forename: Raminta V
authors.initials: RV
authors.lastname: Theriault
authors.affiliation: Department of Orthopaedics, Tufts University School of Medicine, Boston, Massachusetts.
authors.forename: Mary E
authors.initials: ME
authors.lastname: Pevear
authors.affiliation: Department of Orthopaedics, Tufts University School of Medicine, Boston, Massachusetts.
authors.forename: Eric L
authors.initials: EL
authors.lastname: Smith
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000191:economics / Q000639:trends*; D002516:Ceramics / Q000737:chemistry; D003365:Costs and Cost Analysis; D003625:Data Collection; D005260:Female; D017048:Health Care Costs; D006622:Hip Prosthesis / Q000191:economics / Q000706:statistics & numerical data*; D006761:Hospitals; D006801:Humans; D007902:Length of Stay; D008297:Male; D008670:Metals / Q000737:chemistry; D008875:Middle Aged; D010351:Patient Discharge; D020959:Polyethylene; D011474:Prosthesis Design / Q000379:methods*; D011475:Prosthesis Failure; D013499:Surface Properties; D014481:United States; D055815:Young Adult
chemical_list: D008670:Metals; D020959:Polyethylene
keywords: bearing surface; ceramic on ceramic; ceramic on polyethylene; metal on metal; primary total hip arthroplasty; young patients