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Etude des déterminants de la survie prothétique des prothèses de hanche en France, à partir des données du SNIIRAM

Abstract : More and more Total Hip Replacement (THR) are performed in France (PTH) these last decades ; a 10% increase in 4 years has been observed, with 100 000 implantations on 2013.This increase can is related to the ageing of the population as well as the expansion of the implanted population: on one side younger and more active patients are now implanted, and on the other side, older patients (more than 80), often with other comorbidities, are now implanted.Le number of implanted THR, their characteristics, the context of implantation et the characteristics of the implanted population in France have never been comprehensively described so far. Some data are available from international registries (from Nordic, British, North American coutries and Australia), but not in France. The aim of my PhD was to study which factors were associated with the THR survivorship. My research covered the characteristics of the implants, of the patients and of the implanting centers.The data we used were from the French National Health Insurance Information System, SNIIRAM (Système National d'Information Inter-Régimes de l'Assurance Maladie) from 2006 to 2016. About 100 000 THR are implanted annually in France; the total cohort of THR implanted patients between 2006 and 2014 comprises about a million subjects. The cohorts studied in my work comprises between 100 000 and 300 000 patients, included between 2009 and 2012 and followed until 2013 to 2014.These cohorts studies showed that the implants characteristics, bearing surface, cementation, choice of a modular neck are associated with the prosthetic survivorship at short and midterm follow-up. We found the same with the patients characteristics, age, sex, diabetes mellitus as well as exposure to drugs such as benzodiazepines. The characteristics if the implanting center are also associated to the prosthetic survivorship, more specifically the volume of activity of the surgeon who performed the hip arthroplasty.The PMSI data are a valuable tool to perform an active surveillance of THR survivorship and using them allowed us to identify several risk factors of revision at short to midterm follow-up. About 100 000 patients receive a THR annually in France and THR revision is a surgical operation far more complicated than primary implantation, with higher complications rate during and post-operation. Being able to identifiy the factors associated with THR revision and being able to take the measures improving the THR survivorship are indeed a major Public health challenges. Our work' purpose is to assess the current practices and to provide evidences to promote technical choices propitious to THR survivorship, to contribute to health quality improvement.
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Submitted on : Wednesday, January 17, 2018 - 9:33:07 AM
Last modification on : Friday, October 23, 2020 - 5:00:34 PM
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Sandrine Colas. Etude des déterminants de la survie prothétique des prothèses de hanche en France, à partir des données du SNIIRAM. Santé publique et épidémiologie. Université Paris-Saclay, 2017. Français. ⟨NNT : 2017SACLS421⟩. ⟨tel-01686140⟩

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