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BMJ 2011; 342 doi: (Published 27 April 2011) Cite this as: BMJ 2011;342:d2593

Ups and downs during two decades of hip replacements in the US

Every year, 280 000 US adults have a total hip replacement. They are now older, fatter, and more likely to have diabetes, heart failure, and renal failure than they were in 1991, according to an analysis of national insurance data (Medicare). Mortality rates have still fallen, however, particularly after primary operations. By 2008, the risk of dying in the month after surgery was just 0.4% (down from 0.7% in 1991, P<0.001). The risk of dying in hospital was even lower.

Average length of stay after a primary hip replacement has also fallen steadily, from nine days in 1991 to 3.7 in 2008 (P=0.002). But fewer people go straight home, and the proportion discharged to facilities with skilled care, such as rehabilitation centres or nursing homes, is increasing (34.3% in 2008 v 17.8% in 1991). The downward trend in hospital stay has also been accompanied by a recent sharp rise in readmissions, say the authors. Reimbursement structures that encourage early discharge at the expense of patient wellbeing should probably be reconsidered.

The trends for revision arthroplasty were broadly …

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