TOTAL HIP ARTHROPLASTY IN THE PUBLIC HEALTH SYSTEM OF SÃO PAULO: COMPARING TYPES OF FIXATION

GUIMARÃES, RODRIGO PEREIRA; VIAMONT-GUERRA, MARÍA-ROXANA; ANTONIOLI, ELIANE; LENZA, MARIO

doi:10.1590/1413-785220223005e251150

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Acta Ortopédica Brasileira

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ORIGINAL ARTICLE, HIP • Acta ortop. bras. 30 (5) • 2022 • https://doi.org/10.1590/1413-785220223005e251150 copy

TOTAL HIP ARTHROPLASTY IN THE PUBLIC HEALTH SYSTEM OF SÃO PAULO: COMPARING TYPES OF FIXATION

ARTROPLASTIA TOTAL DE QUADRIL NO SISTEMA PÚBLICO DE SÃO PAULO: COMPARANDO OS TIPOS DE FIXAÇÃO

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Brazil lacks registries on the prevalence of primary total hip arthroplasty (THA) fixation methods.

Objective:

(i) to describe the demographic profile of patients who underwent THA in the public health system of the municipality of São Paulo during the last 12 years and (ii) to compare fixation methods regarding costs, hospital stay length, and death rates.

Methods:

This is an ecological study conducted with data available on TabNet, a platform belonging to DATASUS. Public data (from the government health system) on THA procedures performed in São Paulo from 2008 to 2019 were extracted. Gender, age, city region, THA fixation method, number of surgeries, costs, hospital stay length, and death rates were analyzed.

Results:

We analyzed 7,673 THA, of which 6220 (81%) were performed via cementless/hybrid fixation and 1453 (19%), via the cemented technique. Cementless/hybrid fixation had a higher cost (US$ 495.27) than the cemented one (p < 0.001). Nevertheless, hospital stay length was 0.87 days longer for cemented fixation than the cementless/hybrid one. We found no significant difference in death rates between THA fixation methods.

Conclusion:

THA cementless/hybrid fixation is prevalent in the municipality of São Paulo, which had higher total costs and shorter hospitalizations than cemented fixation. We found no difference between THA fixation methods and death rates. Level of Evidence IV, Case Series.

Keywords:
Hip; Arthroplasty Replacement; Public Health; Prosthesis Retention

Year	Exchange (R$ per US$)
2008	1.8346
2009	1.9976
2010	1.7603
2011	1.6750
2012	1.9546
2013	2.1576
2014	2.3534
2015	3.3315
2016	3.4901
2017	3.1920
2018	3.6542
2019	3.9451

	Total (n = 7,673)	Cemented THA (n = 1,453)	Non-cemented/hybrid THA (n = 6,220)	p-value^#
Gender				0.467
Female	3,937 (51.3%)	758 (52.2%)	3,179 (51.1%)
Male	3,736 (48.7%)	695 (47.8%)	3,041 (48.9%)
Age Group				0.004
< 55 years	2,597 (33.8%)	460 (31.7%)	2,137 (34.4%)
55-64 years	2,119 (27.6%)	455 (31.3%)	1,664 (26.8%)
65-74 years	1,988 (25.9%)	353 (24.3%)	1,635 (26.3%)
≥ 75 years	969 (12.6%)	185 (12.7%)	784 (12.6%)
São Paulo Region				< 0.001
Center	801 (10.4%)	449 (30.9%)	352 (5.7%)
East	536 (7.0%)	38 (2.6%)	498 (8.0%)
North	537 (7.0%)	324 (22.3%)	213 (3.4%)
West	1,903 (24.8%)	34 (2.3%)	1,869 (30.0%)
Southeast	3,441 (44.8%)	419 (28.8%)	3,022 (48.6%)
South	455 (5.9%)	189 (13.0%)	266 (4.3%)

	Cemented THA [US$]*	Non-cemented/hybrid THA [US$]*	Difference between non-cemented/hybrid -- cemented [US$]*	p-value
Average total cost	1,345.15	1,840.42	495.27	< 0.001
Average total cost	1,206.97 (1,499.14)	1,639.94 (2,065.41)	406.91 (583.64)	< 0.001
Gender
Female	1,382.71	1,864.69	481.99	< 0.001
Female	1,247.45 (1,532.63)	1,662.28 (2,091.76)	399.55 (564.42)	< 0.001
Male	1,312.21	1,814.46	502.25	< 0.001
Male	1,170.94 (1,470.52)	1,615.35 (2,038.11)	394.11 (610.38)	< 0.001
p-value	0.024	< 0.001
Age group
< 55 years	1,253.35	1,774.14	520.78	< 0.001
< 55 years	1,127.50 (1,393.26)	1,585.77 (1,984.87)	433.21 (608.36)	< 0.001
55-64 years	1,338.85	1,844.79	505.94	< 0.001
55-64 years	1,195.98 (1,498.79)	1,635.54 (2,080.81)	398.87 (613.01)	< 0.001
65-74 years	1,413.86	1,894.00	480.14	< 0.001
65-74 years	1,260.09 (1,586.40)	1,680.20 (2,135.01)	365.35 (594.94)	< 0.001
≥ 75 years	1,457.12	1,912.45	455.34	< 0.001
≥ 75 years	1,295.27 (1,639.19)	1,713.13 (2,134.97)	378.32 (532.35)	< 0.001
p-value	< 0.001	< 0.001
Region
Center	1,487.71	1,763.87	276.16	< 0.001
Center	1,208.94 (1,830.76)	1,428.20 (2,178.43)	206.92 (345.39)	< 0.001
East	1,159.54	1,774.99	615.45	< 0.001
East	989.72 (1,358.50)	1,462.62 (2,154.06)	(391.48; 839.41)	< 0.001
North	994.88	1,123.85	128.97	0.143
North	(842.97; 1,174.18)	(1,076.57; 1,173.21)	(−43.81; 301.75)	0.143
West	1,508.22	1,910.42	402.20	0.039
West	(1,115.64; 2,038.93)	(1,652.17; 2,209.03)	(20.37; 784.03)	0.039
Southeast	1,318.15	1,873.19	555.03	< 0.001
Southeast	(1,213.23; 1,432.15)	(1,547.26; 2,267.77)	(231.11; 878.96)	< 0.001
South	1,412.99	1,707.27	294.27	< 0.001
South	(1,182.93; 1,687.79)	(1,438.70; 2,025.96)	(125.50; 463.05)	< 0.001
p-value	< 0.001	< 0.001

	Cemented THA [US$]*	Non-cemented/Hybrid THA [US$]*	Difference between non-cemented/hybrid - cemented [US$]*	p-value
Average ICU cost	90.73 [64.70; 127.24]	82.35 [68.30; 99.30]	−8.38 (−47.80-31.04)	0.677
Sex
Female	108.64 [82.80; 142.43]	88.84 [73.56; 107.26]	−19.79 (−58.21-18.62)	0.313
Male	75.14 [44.54; 126.30]	75.24 [61.68; 91.73]	0.10 (−46.86-47.05)	0.997
p-value	0.034	< 0.001
Age group
< 55 years	60.28 [32.23; 111.99]	38.42 [30.94; 47.64]	−21.86 (−63.22-19.50)	0.300
55-64 years	89.32 [55.87; 142.47]	77.20 [62.12; 95.87]	−12.13 (−63.86-39.60)	0.646
65-74 years	106.13 [76.67; 146.77]	105.75 (85.45; 130.83)	−0.38 (−51.82; 51.07)	0.989
≥ 75 years	159.79 [115.07; 221.75]	162.93 [139.02; 190.94]	3.14 (−51.65; 57.92)	0.911
p-value	< 0.001	< 0.001
Region
Center	52.85 [28.51; 97.27]	33.11 [25.27; 43.30]	−19.74 (−51.71; 12.23)	0.226
East	249.77 [132.65; 469.51]	37.20 [22.54; 61.00]	−212.56 (−376.00; −49.12)	0.011
North	48.37 [35.77; 65.30]	27.67 [12.27; 60.94]	−20.71 (−55.15; 13.73)	0.239
West	298.28 [125.50; 707.02]	71.34 [61.76; 82.39]	−226.93 (−476.12; 22.25)	0.074
Southeast	119.89 [62.67; 228.53]	108.45 [68.06; 172.45]	−11.45 (−127.28; 104.38)	0.846
South	97.12 [70.63; 133.40]	100.65 [45.19; 222.73]	3.54 (−104.79; 111.86)	0.949
p-value	< 0.001	< 0.001

	Cemented THA*	Non-cemented/hybrid THA*	Difference between non-cemented/hybrid - cemented*	p-value
Average hospitalization	5.42 [5.09; 5.77]	4.55 [4.33; 4.79]	−0.87 (−1.27; −0.46)	< 0.001
Sex
Female	5.77 [5.17; 6.45]	4.60 [4.38; 4.84]	−1.17 (−1.86; −0.48)	0.001
Male	5.12 [4.76; 5.50]	4.50 [4.25; 4.77]	−0.61 (−0.97; −0.26)	< 0.001
p-value	0.087	0.199
Age group
< 55 years	5.58 [5.04; 6.19]	4.33 [4.07; 4.62]	−1.25 (−1.93; −0.57)	< 0.001
55-64 years	5.30 [4.75; 5.91]	4.37 [4.15; 4.60]	−0.93 (−1.52; −0.33)	0.002
65-74 years	5.08 [4.70; 5.48]	4.58 [4.35; 4.82]	−0.49 (−0.89; −0.10)	0.014
≥ 75 years	6.01 [5.43; 6.65]	5.39 [5.05; 5.75]	−0.62 (−1.26; 0.02)	0.059
p-value	0.082	< 0.001
Region
Center	6.37 [5.31; 7.65]	5.22 [4.64; 5.87]	−1.15 (−2.49; 0.18)	0.090
East	6.21 [4.35; 8.87]	5.72 [4.46; 7.34]	−0.49 (−1.40; 0.42)	0.288
North	6.45 [5.59; 7.45]	6.06 [5.13; 7.15]	−0.40 (−1.18; 0.38)	0.318
West	7.06 [5.73; 8.70]	4.47 [4.02; 4.96]	−2.59 (−4.23; −0.96)	0.002
Southeast	4.76 [4.60; 4.93]	4.21 [4.08; 4.34]	−0.55 (−0.66; −0.45)	< 0.001
South	4.70 [3.47; 6.39]	5.00 [4.08; 6.13]	0.30 (−2.05; 2.65)	0.805
p-value	< 0.001	< 0.001

	Cemented THA*	Non-cemented/hybrid THA*	Difference between non-cemented/hybrid - cemented*	p-value
Average ICU stay	0.61 [0.42; 0.88]	0.97 [0.82; 1.14]	0.36 [0.08; 0.65]	0.013
Sex
Female	0.73 [0.52; 0.97]	1.06 [0.90; 1.24]	0.34 [0.05; 0.62]	0.020
Male	0.50 [0.25; 0.81]	0.87 [0.72; 1.04]	0.37 [0.03; 0.71]	0.033
p-value	0.048	< 0.001
Age group
< 55 years	0.41 [0.18; 0.69]	0.43 [0.36; 0.51]	0.02 (−0.25; 0.28)	0.907
55-64 years	0.60 [0.32; 0.94]	0.99 [0.84; 1.15]	0.39 [0.01; 0.77]	0.044
65-74 years	0.72 [0.47; 1.00]	1.29 [1.10; 1.50]	0.58 [0.21; 0.95]	0.002
≥ 75 years	1.02 [0.75; 1.33]	1.65 [1.39; 1.93]	0.63 [0.20; 1.06]	0.004
p-value	< 0.001	< 0.001
Region
Center	0.40 [0.22; 0.61]	0.23 [0.15; 0.32]	−0.17 (−0.35; 0.02)	0.078
East	1.25 [0.69; 2.00]	0.22 [0.08; 0.37]	−1.03 (−1.73; −0.34)	0.004
North	0.32 [0.28; 0.37]	0.18 [0.03; 0.35]	−0.15 (−0.35; 0.06)	0.161
West	1.78 [0.43; 4.39]	0.42 [0.29; 0.57]	−1.36 (−3.09; 0.38)	0.126
Southeast	0.76 [0.25; 1.46]	1.60 [1.21; 2.06]	0.84 (−0.03; 1.72)	0.059
South	0.55 [0.29; 0.85]	0.62 [0.15; 1.28]	0.08 (−0.62; 0.77)	0.832
p-value	0.048	< 0.001

	Cemented THA	Non-cemented/hybrid THA	Difference between non-cemented/hybrid - cemented	p-value
Death rate	0.26 [0.09; 0.76]	0.50 [0.34; 0.73]	0.24% (−0.08%; 0.56%)	0.142
Gender
Female*	0.36% [0.13%; 0.96%]	0.57% [0.32%; 1.05%]	0.22% (−0.22%; 0.66%)	0.333
Male*	0.15% [0.02%; 1.01%]	0.40% [0.25%; 0.63%]	0.24% (−0.15%; 0.64%)	0.225
p-value	0.048	< 0.001
Age group
< 55 years	0.00%	0.09%		N/A
55-64 years	0.00%	0.30%		N/A
65-74 years	0.28%	0.37%		N/A
≥ 75 years	1.62%	2.30%		N/A
p-value	N/A	N/A
Region
Center	0.67%	0.28%		N/A
East	0.00%	0.40%		N/A
North	0.00%	0.94%		N/A
West	0.00%	0.70%		N/A
Southeast	0.24%	0.33%		N/A
South	0.00%	1.13%		N/A
p-value	N/A	N/A

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[1] Correspondence: María-Roxana Viamont-Guerra. Av. Albert Einstein, 627, São Paulo, SP, Brazil, 05652000. roxanaviamontguerra@gmail.com