Quantifying the likelihood and costs of hip replacement surgery after sports injury: A population-level analysis

Highlights

• Sports-related hip injury tripled the likelihood of hip replacement within 15 years.

• This finding was predominantly driven by femoral fractures and hip dislocations.

• Average time from sports-related hip injury to hip replacement was 5 years.

• Hip replacement costs for the sports-injured cohort exceeded $AUD 10 million.

Abstract

Objectives

To quantify the likelihood of hip replacement (HR) surgery at a population level up to 15 years after sports injury.

Design

Cohort study.

Settings

Public and private hospitals in the state of Victoria, Australia.

Participants

The cohort was established by linking administrative datasets capturing all hospital admissions and emergency department (ED) presentations. All sports injury presentations from 2000 to 2005 and HR admissions from 2000 to 2015 were identified using ICD-10-AM codes.

Main outcome measures

Time to HR (number of days from sports injury admission to HR admission).

Results

Over the study period there were 64,750 sports injuries (including 815 hip or thigh musculoskeletal injuries) that resulted in ED presentation or hospitalisation, and 368 HR procedures. Compared to all other sports injuries, having a hip or thigh injury tripled the hazard of subsequent HR in multivariate analysis (hazard ratio 3.07, 95%CI 2.00–4.72). Of the main hip or thigh injury types, femoral fractures (hazard ratio 3.08, 95%CI 1.77–5.36) and hip dislocations (hazard ratio 5.64, 95%CI 2.34–13.58) were significantly associated with HR.

Conclusion

Sports-related hip or thigh musculoskeletal injury is associated with a significantly higher likelihood of HR within 15 years. Effective injury prevention and appropriate post-injury management are needed to curtail this population burden.

Introduction

Osteoarthritis (OA) of the knee has long been recognised as a downstream consequence of knee injury (Lohmander et al., 2007; Roos, 2005), with injuries commonly sustained during sport. Our recent population-based research showed that having a sports-related knee injury more than doubled the likelihood of knee replacement surgery within 15 years, compared to all other sports injuries (Ackerman, Bohensky, & Kemp, 2019). The link between sports injury and hip replacement (HR) for OA is not as clear. An early case-control study from the United Kingdom found that prior hip injury was an independent risk factor for hip OA (Cooper et al., 1998) and longitudinal research from Finland reported the risk of developing hip OA was 5 times higher for people who had sustained any previous musculoskeletal injury (Juhakoski et al., 2009). With regard to sports-related injuries, a review of systematic reviews concluded there was moderate to strong evidence that high-intensity sporting activity is a risk factor for hip OA (Bierma-Zeinstra & Koes, 2007), although this could relate to repetitive joint loading as well as acute injury. A more recent systematic review reported that elite-level impact sport participation was associated with a 1.8–8.7 times increased odds of hip OA (variably defined as radiographic OA or progression to HR surgery), when compared with matched controls (Vigdorchik et al., 2016). However, the contribution of sports injury to HR risk was not specifically investigated.

While elite or professional athletes represent a unique group in which to examine sports injuries and their sequelae (given training volume and regular competitive participation), these findings may not be generalisable to the broader community where recreational or amateur sport participation is more common. To better understand the burden of HR after sports injury, a population-based approach is required. This is particularly important as lower limb sports-related injury rates are rising in the general community, with implications for future OA burden (Finch, Kemp, & Clapperton, 2015). The present study aimed to:

• quantify the likelihood of HR 10–15 years after sports-related hip or thigh injury, compared to other types of sports injuries; and

• estimate the cost burden of HR surgery after sports-related injury at a state level.