Avascular necrosis of the femoral head is a disabling condition that affects mainly young male adults. High disease incidence was noted in oriental people as in Taiwan, but there has been no official report related to the epidemiology and outcome of surgical treatment including nonarthroplastic and arthroplastic procedures up to now.
In this study, database of the National Health Insurance in 8-year interval from 1997 to 2004 was reviewed and epidemiology of hip replacement surgery in Taiwan was investigated. The survival analysis of hip replacement surgery was executed.
The patients with the index diagnosis of avascular necrosis of the femoral head underwent hip surgery including core decompression and joint replacement procedures in 8-year interval from 1997 to 2004 were enrolled as the subjects of this study. Eight-year clinical course of all individuals enrolled in this study were traced according to the claimed items and figures in the NHI database. More than 100,000 cases were adopted and in this study.
Related items were adopted from main categories of NHI database including registry for contracted medical facilities, registry for medical personnel, monthly claim summary for inpatient claims, inpatient expenditures by admissions, inpatient expenditures by admissions, and national death register. Data from specific items were linked in case-mixed manner and calculated for development of epidemiologic profiles.
The endpoint for prosthetic survival was defined as revision when a part of, or the whole implant was exchanged, and end point of core decompression was defined as primary prosthetic replacement procedure performed after core decompression of the affected femoral head. Survival analysis of the surgical procedures was estimated for diseases， implants, and other specific parameter by the Kaplan-Meier method. Epidemiologic data, revision burden and cumulated survival rate are identified and survival curve for specific parameter are plotted.
In this eight-year cohort study for avascular necrosis of the femoral head, there are totally 14,392 THR procedures, 8,424 hemiarthroplasty procedures and 1,420 core decompression procedures. All these three main surgical procedures for the treatment of ANFH showed annually increased trend. Male predominance (M:F=4:1) is just the same as those mentioned in all other articles.. More than 50% of all cases occurred between 30-50 year-old .43.80 % of all THR procedure were performed with the index diagnosis of ANFH and 17.09 % of all hemiarthroplasty. Procedures were performed under the index diagnosis of ANFH. More than 90% of the affected hips were treated with arthroplastic procedures in Taiwan. There were only limited cases of core decompression procedures with final results inferior to the results of western articles. The treatment for early collapsed femoral head with radiographicaly intact acetabular cartilage, either bipolar prosthesis replacement or total hip replacement revealed same result with about 95% implant survival.eight years after operation.
For accurate monitoring of the treatment result of this formidable disease, modification of the NHI claim system to fit the need of joint registry is necessary for quality improvement and expenditure saving. |
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